Sandbox brain abscess: Difference between revisions
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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]]. | 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== | |||
=====Preferred regimen===== | |||
{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} {{and}} {{abx|Metronidazole 30 mg/kg/day q6h}} | |||
=====Alternative regimen===== | |||
{{abx|Meropenem 6 g/day q8h}} | |||
====Transplant recipients==== | |||
{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} {{and}} {{abx|Metronidazole 30 mg/kg/day q6h}} {{and}} {{abx|Voriconazole 8 mg/kg/day q12h}} {{and}} {{abx|TMP-SMZ 10–20 mg/kg/day q6–12h|Sulfadiazine 4–6 g/day q6h}} | |||
====Patients with HIV/AIDS==== | |||
{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} {{and}} {{abx|Metronidazole 30 mg/kg/day q6h}} {{and}} {{abx|Sulfadiazine 4–6 g/day q6h}} {{and}} {{abx|Pyrimethamine 25–100 mg/day qd}} | |||
====''Staphylococcus aureus'' coverage==== | |||
{{abx|Vancomycin 30–45 mg/kg/day q8–12h}} | |||
====''Mycobacterium tuberculosis'' coverage==== | |||
{{abx|Vancomycin 30–45 mg/kg/day q8–12h}} {{and}} {{abx|Isoniazid 300 mg qd}} {{and}} {{abx|Rifampin 600 mg qd}} {{and}} {{abx|Pyrazinamide 15–30 mg qd}} {{and}} {{abx|Ethambutol 15 mg/kg/day qd}} | |||
==Antimicrobial Therapy – Pathogen-Based Therapy== | |||
====''Actinomyces''==== | |||
{{abx|Penicillin G 24 MU q4h}} | |||
====''Bacteroides fragilis''==== | |||
{{abx|Metronidazole 30 mg/kg/day q6h}} | |||
====''Enterobacteriaceae''==== | |||
{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} | |||
====''Fusobacterium''==== | |||
{{abx|Metronidazole 30 mg/kg/day q6h}} | |||
====''Haemophilus''==== | |||
{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} | |||
====''Listeria monocytogenes''==== | |||
{{abx|Ampicillin 12 g/day q4h|Penicillin G 24 MU q4h}} | |||
====''Nocardia''==== | |||
{{abx|TMP-SMZ 10–20 mg/kg/day q6–12h|Sulfadiazine 4–6 g/day q6h}} | |||
====''Prevotella melaninogenica''==== | |||
{{abx|Metronidazole 30 mg/kg/day q6h}} | |||
====''Pseudomonas aeruginosa''==== | |||
{{abx|Ceftazidime 6 g/day q8h|Cefepime 6 g/day q8h}} | |||
====Methicillin-Sensitive ''Staphylococcus aureus''==== | |||
{{abx|Nafcillin 12 g/day q4h|Oxacillin 12 g/day q4h}} | |||
====Methicillin-resistant ''Staphylococcus aureus''==== | |||
{{abx|Vancomycin 30–45 mg/kg/day q8–12h}} | |||
====''Streptococcus anginosus'' and other ''Streptococci''==== | |||
{{abx|Penicillin G 24 MU q4h}} | |||
====''Aspergillus''==== | |||
{{abx|Voriconazole 8 mg/kg/day q12h}} | |||
====''Candida''==== | |||
{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}} | |||
====''Cryptococcus neoformans''==== | |||
{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}} | |||
====''Mucorales''==== | |||
{{abx|Amphotericin B lipid complex 5 mg/kd/day q24h|Amphotericin B deoxycholate 15 mg/kg/day q8h}} | |||
====''Pseudallescheria boydii (Scedosporium apiospermum)''==== | |||
{{abx|Voriconazole 8 mg/kg/day q12h}} | |||
====''Toxoplasma gondii''==== | |||
{{abx|Sulfadiazine 4–6 g/day q6h}} {{and}} {{abx|Pyrimethamine 25–100 mg/day qd}} | |||
==References== | ==References== |
Revision as of 16:04, 17 April 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Brain abscess Microchapters |
Diagnosis |
Treatment |
Case Studies |
Sandbox brain abscess On the Web |
American Roentgen Ray Society Images of Sandbox brain abscess |
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
Preferred regimen
Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND Metronidazole 30 mg/kg/day q6h
Alternative regimen
Meropenem 6 g/day q8h
Transplant recipients
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
Patients with HIV/AIDS
Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h AND Metronidazole 30 mg/kg/day q6h AND Sulfadiazine 4–6 g/day q6h AND Pyrimethamine 25–100 mg/day qd
Staphylococcus aureus coverage
Vancomycin 30–45 mg/kg/day q8–12h
Mycobacterium tuberculosis coverage
Vancomycin 30–45 mg/kg/day q8–12h AND 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
Actinomyces
Penicillin G 24 MU q4h
Bacteroides fragilis
Metronidazole 30 mg/kg/day q6h
Enterobacteriaceae
Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
Fusobacterium
Metronidazole 30 mg/kg/day q6h
Haemophilus
Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h
Listeria monocytogenes
Ampicillin 12 g/day q4h OR Penicillin G 24 MU q4h
Nocardia
TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h
Prevotella melaninogenica
Metronidazole 30 mg/kg/day q6h
Pseudomonas aeruginosa
Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h
Methicillin-Sensitive Staphylococcus aureus
Nafcillin 12 g/day q4h OR Oxacillin 12 g/day q4h
Methicillin-resistant Staphylococcus aureus
Vancomycin 30–45 mg/kg/day q8–12h
Streptococcus anginosus and other Streptococci
Penicillin G 24 MU q4h
Aspergillus
Voriconazole 8 mg/kg/day q12h
Candida
Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
Cryptococcus neoformans
Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
Mucorales
Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
Pseudallescheria boydii (Scedosporium apiospermum)
Voriconazole 8 mg/kg/day q12h
Toxoplasma gondii
Sulfadiazine 4–6 g/day q6h AND Pyrimethamine 25–100 mg/day qd