Sandbox brain abscess: Difference between revisions

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Gerald Chi (talk | contribs)
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<li>[[Meropenem]] 6 g/day q8h</li>
<li>[[Meropenem]] 6 g/day q8h</li>
</ul>
</ul>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Transplant recipients" data-collapsetext="Transplant recipients">
{{rx|Transplant recipients}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h {{and}} </li>
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h {{and}} </li>
<li>[[Metronidazole]] 30 mg/kg/day q6h {{and}} </li>
<li>[[Metronidazole]] 30 mg/kg/day q6h {{and}} </li>
Line 20: Line 20:
<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h <u>OR</u> [[Sulfadiazine]] 4–6 g/day q6h</li>
<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h <u>OR</u> [[Sulfadiazine]] 4–6 g/day q6h</li>
</ul>
</ul>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Patients with HIV/AIDS" data-collapsetext="Patients with HIV/AIDS">
{{rx|Patients with HIV/AIDS}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h {{and}} </li>
<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h {{and}} </li>
<li>[[Sulfadiazine]] 4–6 g/day q6h {{and}} </li>
<li>[[Sulfadiazine]] 4–6 g/day q6h {{and}} </li>
<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
</ul>
</ul>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Staphylococcus aureus coverage" data-collapsetext="Staphylococcus aureus coverage">
{{rx|Staphylococcus aureus coverage}}
<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
</ul>
</ul>
<ul class="mw-collapsible mw-collapsed" data-expandtext="Mycobacterium tuberculosis coverage" data-collapsetext="Mycobacterium tuberculosis coverage">
{{rx|Mycobacterium tuberculosis coverage}}
<li>[[Isoniazid]] 300 mg qd {{and}} </li>
<li>[[Isoniazid]] 300 mg qd {{and}} </li>
<li>[[Rifampin]] 600 mg qd {{and}} </li>
<li>[[Rifampin]] 600 mg qd {{and}} </li>
Line 36: Line 36:


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

Revision as of 02:06, 19 April 2015

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

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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

    • <ul class="mw-collapsible mw-collapsed" data-expandtext="Pseudallescheria boydii (Scedosporium apiospermum)" data-collapsetext="Pseudallescheria boydii (Scedosporium apiospermum)}}

  • Voriconazole 8 mg/kg/day q12h
  • Sulfadiazine 4–6 g/day q6h
    <span style="text-indent: 50px;}}AND
  • Pyrimethamine 25–100 mg/day qd

    • References

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