Sandbox brain abscess

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

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Voriconazole 8 mg/kg/day q12h

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