Sandbox brain abscess: Difference between revisions

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Revision as of 02:56, 18 April 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Treatment of brain abscess requires a multidisciplinary approach to delineate extent of infection, plan stereotactic trajectory, aspirate purulent materials, lower intracranial pressure, identify causative pathogen, and administer appropriate antibiotics.

Antimicrobial Therapy – Empiric Therapy

Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
AND
Metronidazole 30 mg/kg/day q6h

Meropenem 6 g/day q8h

Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
AND
Metronidazole 30 mg/kg/day q6h
AND
Voriconazole 8 mg/kg/day q12h
AND
TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h

Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
AND
Sulfadiazine 4–6 g/day q6h
AND
Pyrimethamine 25–100 mg/day qd

Vancomycin 30–45 mg/kg/day q8–12h

Isoniazid 300 mg qd
AND
Rifampin 600 mg qd
AND
Pyrazinamide 15–30 mg qd
AND
Ethambutol 15 mg/kg/day qd

Antimicrobial Therapy – Pathogen-Based Therapy

Penicillin G 24 MU q4h

Metronidazole 30 mg/kg/day q6h

Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

Metronidazole 30 mg/kg/day q6h

Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

Ampicillin 12 g/day q4h OR Penicillin G 24 MU q4h

TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h

Metronidazole 30 mg/kg/day q6h

Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h

Nafcillin 12 g/day q4h OR Oxacillin 12 g/day q4h

Vancomycin 30–45 mg/kg/day q8–12h

Penicillin G 24 MU q4h

Voriconazole 8 mg/kg/day q12h

Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h

Voriconazole 8 mg/kg/day q12h

Sulfadiazine 4–6 g/day q6h
AND
Pyrimethamine 25–100 mg/day qd

References

@@ Line 36: / Line 36: @@
 ==Antimicrobial Therapy – Pathogen-Based Therapy==
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Actinomyces" data-collapsetext="Actinomyces">
-====''Actinomyces''====
+<li>[[Penicillin G]] 24 MU q4h</li>
-{{abx|Penicillin G 24 MU q4h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Bacteroides fragilis" data-collapsetext="Bacteroides fragilis">
-====''Bacteroides fragilis''====
+<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
-{{abx|Metronidazole 30 mg/kg/day q6h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Enterobacteriaceae" data-collapsetext="Enterobacteriaceae">
-====''Enterobacteriaceae''====
+<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h</li>
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Fusobacterium" data-collapsetext="Fusobacterium">
-====''Fusobacterium''====
+<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
-{{abx|Metronidazole 30 mg/kg/day q6h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Haemophilus" data-collapsetext="Haemophilus">
-====''Haemophilus''====
+<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h</li>
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Listeria monocytogenes" data-collapsetext="Listeria monocytogenes">
-====''Listeria monocytogenes''====
+<li>[[Ampicillin]] 12 g/day q4h <u>OR</u> [[Penicillin G]] 24 MU q4h</li>
-{{abx|Ampicillin 12 g/day q4h|Penicillin G 24 MU q4h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Nocardia" data-collapsetext="Nocardia">
-====''Nocardia''====
+<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h <u>OR</u> [[Sulfadiazine]] 4–6 g/day q6h</li>
-{{abx|TMP-SMZ 10–20 mg/kg/day q6–12h|Sulfadiazine 4–6 g/day q6h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Prevotella melaninogenica" data-collapsetext="Prevotella melaninogenica">
-====''Prevotella melaninogenica''====
+<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
-{{abx|Metronidazole 30 mg/kg/day q6h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Pseudomonas aeruginosa" data-collapsetext="Pseudomonas aeruginosa">
-====''Pseudomonas aeruginosa''====
+<li>[[Ceftazidime]] 6 g/day q8h <u>OR</u> [[Cefepime]] 6 g/day q8h</li>
-{{abx|Ceftazidime 6 g/day q8h|Cefepime 6 g/day q8h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Methicillin-Sensitive Staphylococcus aureus" data-collapsetext="Methicillin-Sensitive Staphylococcus aureus">
-====Methicillin-Sensitive ''Staphylococcus aureus''====
+<li>[[Nafcillin]] 12 g/day q4h <u>OR</u> [[Oxacillin]] 12 g/day q4h</li>
-{{abx|Nafcillin 12 g/day q4h|Oxacillin 12 g/day q4h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Methicillin-resistant Staphylococcus aureus" data-collapsetext="Methicillin-resistant Staphylococcus aureus">
-====Methicillin-resistant ''Staphylococcus aureus''====
+<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
-{{abx|Vancomycin 30–45 mg/kg/day q8–12h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Streptococcus anginosus and other streptococci" data-collapsetext="Streptococcus anginosus and other streptococci">
-====''Streptococcus anginosus'' and other ''Streptococci''====
+<li>[[Penicillin G]] 24 MU q4h</li>
-{{abx|Penicillin G 24 MU q4h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Aspergillus" data-collapsetext="Aspergillus">
-====''Aspergillus''====
+<li>[[Voriconazole]] 8 mg/kg/day q12h</li>
-{{abx|Voriconazole 8 mg/kg/day q12h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Candida" data-collapsetext="Candida">
-====''Candida''====
+<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h <u>OR</u> [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
-{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Cryptococcus neoformans" data-collapsetext="Cryptococcus neoformans">
-====''Cryptococcus neoformans''====
+<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h <u>OR</u> [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
-{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Mucorales" data-collapsetext="Mucorales">
-====''Mucorales''====
+<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h <u>OR</u> [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
-{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Pseudallescheria boydii (Scedosporium apiospermum)" data-collapsetext="Pseudallescheria boydii (Scedosporium apiospermum)">
-====''Pseudallescheria boydii (Scedosporium apiospermum)''====
+<li>[[Voriconazole]] 8 mg/kg/day q12h</li>
-{{abx|Voriconazole 8 mg/kg/day q12h}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Toxoplasma gondii" data-collapsetext="Toxoplasma gondii">
-====''Toxoplasma gondii''====
+<li>[[Sulfadiazine]] 4–6 g/day q6h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
-{{abx|Sulfadiazine 4–6 g/day q6h}} {{and}} {{abx|Pyrimethamine 25–100 mg/day qd}}
+<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
+</ul>
 ==References==