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::* '''Intracranial subdural empyema after neurosurgical procedures'''
::* '''Intracranial subdural empyema after neurosurgical procedures'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Ceftazidime]]
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Ceftazidime]] 2 g IV q8h





Revision as of 04:53, 8 June 2015

Subdural empyema ⇧ Return to Top ⇧
  • Causative pathogens
  • More common
  • Streptococcus milleri
  • Other streptococci and enterococci
  • Aerobic Gram-negative bacilli (Haemophilus influenzae, Proteus, Escherichia coli, Pseudomonas, Klebsiella, Acinetobacter, Salmonella, Morganella, Eikenella)
  • No growth
  • Less common
  • Streptococcus pneumoniae
  • Staphylococcus aureus, coagulase-negative staphylococci
  • Anaerobic Gram-positive cocci (Veillonella, Peptostreptococcus, others)
  • Anaerobic Gram-negative bacilli (Bacteroides, Fusobacterium, Prevotella)
  • Empiric antimicrobial therapy
  • Intracranial subdural empyema with unclear source of infection
Note: Vancomycin should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • Intracranial subdural empyema associated with sinusitis or otitis media
Note: Vancomycin should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • Intracranial subdural empyema after cranial trauma
Note: Vancomycin should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • Intracranial subdural empyema after neurosurgical procedures



Note (1): The choice of antimicrobial agent should be based on Gram stain results and the likely causative microorganisms.
Note (2): Metronidazole is recommended if anaerobes are suspected. Metronidazole is not necessary for antianaerobic activity if Meropenem is used.
Note (3): For coverage of aerobic Gram-negative bacilli, empiric therapy with Cefepime, Ceftazidime, or Meropenem is appropriate.
Note (4): Depending on the clinical response, parenteral antimicrobial therapy should be administered for 3 to 4 weeks after drainage. Parenteral or oral therapy is frequently continued for up to a total of 6 weeks of therapy.
Note (5): A longer course of treatment (minimum of 6–8 weeks) may be required if the patient has accompanying osteomyelitis.
Note (6): Consider adjunctive medications including prophylactic anticonvulsants, corticosteroids, and mannitol if clinically indicated.
  • Pathogen-directed antimicrobial therapy
  • Staphylococcus aureus, methicillin-resistant (MRSA)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
  • Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin.


  1. Osborn, Melissa K.; Steinberg, James P. (2007-01). "Subdural empyema and other suppurative complications of paranasal sinusitis". The Lancet. Infectious Diseases. 7 (1): 62–67. doi:10.1016/S1473-3099(06)70688-0. ISSN 1473-3099. PMID 17182345. Check date values in: |date= (help)
  2. Greenlee, John E. (2003-01). "Subdural Empyema". Current Treatment Options in Neurology. 5 (1): 13–22. ISSN 1092-8480. PMID 12521560. Check date values in: |date= (help)