Sandbox g14
Epidural abscess
- Empiric antimicrobial therapy
- Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks AND Ceftriaxone 2 g Iv q24h for 2–4 weeks, then PO to complete 6–8 weeks
- Note (1): Decompressive laminectomy in conjunction with long-term antibiotic therapy tailored to culture results is required.
- Note (2): For critically ill patients, a vancomycin loading dose of 20–25 mg/kg may be considered.
- Culture-directed antimicrobial therapy
- Penicillin-susceptible Staphylococcus aureus or Streptococcus
- Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
- Methicillin-susceptible Staphylococcus aureus or Streptococcus
- Preferred regimen: Cefazolin 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks OR Nafcillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR Oxacillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
- Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
- Methicillin-resistant Staphylococcus aureus
- Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
- Streptococcus or Enterococcus
- Preferred regimen: Penicillin G 3–4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR Ampicillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
- Enterobacteriaceae
- Preferred regimen: ceftriaxone 1-2 g IV q12h or cefotaxime 2 g IV q6-8h
- Gram-negative bacteria
- Preferred regimen: ceftazidime 2 g IV q8h or cefepime 2 g IV q12h
- Alternative regimen: Ciprofloxacin 400 mg IV q12h or levofloxacin 750 mg IV once daily or moxifloxacin 400 mg IV once daily
- Anaerobes
- Preferred regimen: metronidazole 500 mg IV q6h
- Staphylococcus, Gram-negative bacteria, and anaerobes (mixed infection)
- Preferred regimen: ampicillin/sulbactam 3 g IV q6h or ticarcillin/clavulanate 3.1 g IV q4h or piperacillin/tazobactam 3.375 g IV q4-6h
- Alternative regimen: imipenem 500-1000 mg IV q6h or meropenem 1-2 g IV q8h
Brain abscess
- Brain abscess, bacterial[4]
- Empiric antimicrobial therapy
- Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h AND (Cefotaxime 2 g IV q4h OR Ceftriaxone 2 g IV q12h) AND Metronidazole 7.5 mg/kg q6h or 15 mg/kg q12h
- Alternative regimen: Penicillin 15–20 mg/kg IV q8–12h AND (Cefotaxime 2 g IV q4h OR Ceftriaxone 2 g IV q12h) AND Metronidazole 7.5 mg/kg q6h or 15 mg/kg q12h
- Brain abscess, tuberculous
- Brain abscess, fungal
References
- ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.