Sandbox brain abscess: Difference between revisions

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Revision as of 02:39, 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

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

References

@@ Line 7: / Line 7: @@
 ==Antimicrobial Therapy – Empiric Therapy==
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Preferred regimen" data-collapsetext="Preferred regimen">
-=====Preferred regimen=====
+<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
-{{abx|Cefotaxime 8–12 g/day q4–6h|Ceftriaxone 4 g/day q12h}} {{and}} {{abx|Metronidazole 30 mg/kg/day q6h}}
+<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
+</ul>
-=====Alternative regimen=====
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Alternative regimen" data-collapsetext="Alternative regimen">
-{{abx|Meropenem 6 g/day q8h}}
+<li>[[Meropenem]] 6 g/day q8h</li>
+</ul>
-====Transplant recipients====
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Transplant recipients" data-collapsetext="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}}
+<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
+<li>[[Metronidazole]] 30 mg/kg/day q6h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
-====Patients with HIV/AIDS====
+<li>[[Voriconazole]] 8 mg/kg/day q12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
-{{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}}
+<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h <u>OR</u> [[Sulfadiazine]] 4–6 g/day q6h</li>
+</ul>
-====''Staphylococcus aureus'' coverage====
+<ul class="mw-collapsible mw-collapsed" data-expandtext="Patients with HIV/AIDS" data-collapsetext="Patients with HIV/AIDS">
-{{abx|Vancomycin 30–45 mg/kg/day q8–12h}}
+<li>[[Cefotaxime]] 8–12 g/day q4–6h <u>OR</u> [[Ceftriaxone]] 4 g/day q12h<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>
-====''Mycobacterium tuberculosis'' coverage====
+<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
-{{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}}
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="''Staphylococcus aureus'' coverage" data-collapsetext="''Staphylococcus aureus'' coverage">
+<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
+</ul>
+<ul class="mw-collapsible mw-collapsed" data-expandtext="''Mycobacterium tuberculosis'' coverage" data-collapsetext="''Mycobacterium tuberculosis'' coverage">
+<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
+<li>[[Isoniazid]] 300 mg qd<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
+<li>[[Rifampin]] 600 mg qd<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
+<li>[[Pyrazinamide]] 15–30 mg qd<BR><span style="text-indent: 50px;"><u>AND</u></span></li>
+<li>[[Ethambutol]] 15 mg/kg/day qd</li>
+</ul>
 ==Antimicrobial Therapy – Pathogen-Based Therapy==

Sandbox brain abscess: Difference between revisions

Revision as of 02:39, 18 April 2015

Overview

Antimicrobial Therapy – Empiric Therapy

Antimicrobial Therapy – Pathogen-Based Therapy

Actinomyces

Bacteroides fragilis

Enterobacteriaceae

Fusobacterium

Haemophilus

Listeria monocytogenes

Nocardia

Prevotella melaninogenica

Pseudomonas aeruginosa

Methicillin-Sensitive Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus

Streptococcus anginosus and other Streptococci

Aspergillus

Candida

Cryptococcus neoformans

Mucorales

Pseudallescheria boydii (Scedosporium apiospermum)

Toxoplasma gondii

References

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