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Treatment of brain abscess requires a multidisciplinary approach to lower [[intracranial pressure]], delineate extent of infection, evacuate [[purulent]] materials, administer appropriate [[antibiotics]], and obtain tissue specimens.
Treatment of brain abscess requires a multidisciplinary approach to lower [[intracranial pressure]], delineate extent of infection, evacuate [[purulent]] materials, administer appropriate [[antibiotics]], and obtain tissue specimens.


==Treatment==
==Medical Therapy==
Initial treatment includes lowering the [[intracranial pressure]] and administering empiric [[antibiotic]]s.  Stereotactic needle biopsy can be performed to obtain tissues for cultures.
Initial treatment includes lowering the [[intracranial pressure]] and administering empiric [[antibiotic]]s.  Stereotactic needle biopsy can be performed to obtain tissues for cultures.


Line 32: Line 32:
:* [[Anticonvulsant]]s are recommended prophylactically for the 1st 3m, though the data supporting this is lacking.<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>
:* [[Anticonvulsant]]s are recommended prophylactically for the 1st 3m, though the data supporting this is lacking.<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>


==Antimicrobial Regimen – Empiric Therapy==
==Antimicrobial Regimen==


===Brain Abscess in Otherwise Healthy Patients===
====Brain abscess====
{{rx|Preferred regimen}}
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
* [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Alternative regimen}}
* [[Meropenem]] 6 g/day q8h
</li>


===Brain Abscess with Comorbidities===
* Empiric antimicrobial therapy<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
{{rx|Otitis media, mastoiditis, or sinusitis}}
: Note:  The optimal duration of antimicrobial therapy remains unclear.  A 4- to 6-week course of treatment is usually required.
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
* [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Dental infection}}
* [[Penicillin G]] 24 MU q4h {{and}}
* [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Penetrating trauma or post-neurosurgy}}
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</li>
{{rx|Lung abscess, empyema, or bronchiectasis}}
* [[Penicillin G]] 24 MU q4h {{and}}
* [[Metronidazole]] 30 mg/kg/day q6h {{and}}
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
</li>
{{rx|Bacterial endocarditis}}
* [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}}
* [[Gentamicin]] 5 mg/kg/day IV q8h
</li>
{{rx|Congenital heart disease}}
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
</li>
{{rx|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
</li>
{{rx|Patients with HIV/AIDS}}
* [[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
</li>
{{rx|Staphylococcus aureus coverage}}
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</li>
{{rx|Mycobacterium tuberculosis coverage}}
* [[Isoniazid]] 300 mg qd {{and}}
* [[Rifampin]] 600 mg qd {{and}}
* [[Pyrazinamide]] 15–30 mg qd {{and}}
* [[Ethambutol]] 15 mg/kg/day qd
</li>


==Antimicrobial Regimen – Pathogen-Based Therapy==
:* '''Brain abscess in otherwise healthy patients'''
::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day IV q4–6h {{or}} [[Ceftriaxone]] 4 g/day IV q12h) {{and}} [[Metronidazole]] 30 mg/kg/day IV q6h
::* Alternative regimen: [[Meropenem]] 6 g/day IV q8h


===Bacteria===
:* Brain abscess with comorbidities
{{rx|Actinomyces}}
::* '''Otitis media, mastoiditis, or sinusitis'''
* [[Penicillin G]] 24 MU q4h
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h) {{and}} [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Bacteroides fragilis}}
* [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Enterobacteriaceae}}
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
</li>
{{rx|Fusobacterium}}
* [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Haemophilus}}
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
</li>
{{rx|Listeria monocytogenes}}
* [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h
</li>
{{rx|Nocardia}}
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
</li>
{{rx|Prevotella melaninogenica}}
* [[Metronidazole]] 30 mg/kg/day q6h
</li>
{{rx|Pseudomonas aeruginosa}}
* [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
</li>
{{rx|Methicillin-sensitive Staphylococcus aureus}}
* [[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h
</li>
{{rx|Methicillin-resistant Staphylococcus aureus}}
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</li>
{{rx|Streptococcus anginosus and other streptococci}}
* [[Penicillin G]] 24 MU q4h
</li>


===Fungi===
::* '''Dental infection'''
{{rx|Aspergillus}}
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h
* [[Voriconazole]] 8 mg/kg/day q12h
</li>
{{rx|Candida}}
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</li>
{{rx|Cryptococcus neoformans}}
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</li>
{{rx|Mucorales}}
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</li>
{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}}
* [[Voriconazole]] 8 mg/kg/day q12h
</li>


===Protozoa===
::* '''Penetrating trauma or post-neurosurgy'''
{{rx|Toxoplasma gondii}}
:::* Preferred regimen: ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{or}} [[Cefepime]] 2 g IV q12h) {{and}} [[Vancomycin]] 30–45 mg/kg/day q8–12h
* [[Sulfadiazine]] 4–6 g/day q6h {{and}}
* [[Pyrimethamine]] 25–100 mg/day qd
</li>


::* '''Lung abscess, empyema, or bronchiectasis'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{and}} [[Metronidazole]] 30 mg/kg/day q6h {{and}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
::* '''Bacterial endocarditis'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
::* '''Congenital heart disease'''
:::* Preferred regimen: [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
::* '''Transplant recipients'''
:::* Preferred regimen: ([[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'''
:::* Preferred regimen: ([[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
::*  '''Staphylococcus aureus coverage'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day q8–12h
::* '''Mycobacterium tuberculosis coverage'''
:::* Preferred regimen: [[Isoniazid]] 300 mg qd {{and}} [[Rifampin]] 600 mg qd {{and}} [[Pyrazinamide]] 15–30 mg qd {{and}} [[Ethambutol]] 15 mg/kg/day qd
* Pathogen-directed antimicrobial therapy<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
: Note:  The optimal duration of antimicrobial therapy remains unclear.  A 4- to 6-week course of treatment is usually required.
:* Bacteria
::* '''Actinomyces'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
::* '''Bacteroides fragilis'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day IV q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h
::* '''Enterobacteriaceae'''
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h
::* '''Fusobacterium'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
::* '''Haemophilus'''
:::* Preferred regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefepime]] 2 g IV q12h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
::* '''Listeria monocytogenes'''
:::* Preferred regimen: [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 4 MU IV q4h
:::* Alternative regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
::* '''Nocardia'''
:::* Preferred regimen: [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
:::* Alternative regimen: [[Meropenem]] 2 g IV q8h {{or}} [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Amikacin]] 15 mg/kg/day IV q8h
::* '''Prevotella melaninogenica'''
:::* Preferred regimen: [[Metronidazole]] 30 mg/kg/day q6h
:::* Alternative regimen: [[Clindamycin]] 2400–4800 mg/day IV q6h {{or}} [[Meropenem]] 2 g IV q8h
::* '''Pseudomonas aeruginosa'''
:::* Preferred regimen: [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Ciprofloxacin]] 800–1200 mg/day IV q8–12h {{or}} [[Meropenem]] 2 g IV q8h
::* '''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.
::* '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
:::* Preferred regimen: [[Nafcillin]] 2 g IV q4h {{or}} [[Oxacillin]] 2 g IV q4h
:::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::* '''Streptococcus'''
:::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h {{or}} [[Ampicillin]] 2 g IV q4h
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q4-6h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
:* Fungi
::* '''Aspergillus'''
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Alternative regimen: [[Amphotericin B]] deoxycholate 0.6–1.0 mg/kg/day IV q24h {{or}} [[Amphotericin B]] lipid complex 5 mg/kg/day IV q24h {{or}} [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
::* '''Candida'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
::* '''Cryptococcus neoformans'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Fluconazole]] 400–800 mg/day IV q24h
::* '''Mucorales'''
:::* Preferred regimen: [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
:::* Alternative regimen: [[Posaconazole]] 800 mg/kg/day IV q6–12h
::* '''Pseudallescheria boydii (Scedosporium apiospermum)'''
:::* Preferred regimen: [[Voriconazole]] 8 mg/kg/day q12h
:::* Alternative regimen: [[Itraconazole]] 400–600 mg/day IV q12h {{or}} [[Posaconazole]] 800 mg/kg/day IV q6–12h
:* Protozoa
::* '''Toxoplasma gondii'''
:::* Preferred regimen: [[Sulfadiazine]] 4–6 g/day q6h {{and}} [[Pyrimethamine]] 25–100 mg/day qd
:::* Alternative regimen (1): [[Pyrimethamine]] 25–100 mg/day qd {{and}} [[Clindamycin]] 2400–4800 mg/day IV q6h
:::* Alternative regimen (2): [[Pyrimethamine]] 25–100 mg/day qd {{and}} ([[Azithromycin]] 1200–1500 mg/day IV q24h {{or}} [[Atovaquone]] 750 mg IV q6h {{or}} [[Dapsone]] 100 mg PO q24h)
:::* Alternative regimen (3): [[TMP-SMZ]] 10–20 mg/kg/day q6–12h
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 23:33, 8 June 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sheng Shi, M.D. [2]

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Overview

Treatment of brain abscess requires a multidisciplinary approach to lower intracranial pressure, delineate extent of infection, evacuate purulent materials, administer appropriate antibiotics, and obtain tissue specimens.

Medical Therapy

Initial treatment includes lowering the intracranial pressure and administering empiric antibiotics. Stereotactic needle biopsy can be performed to obtain tissues for cultures.

A brain abscess greater than 3 cm in diameter should be considered for surgical drainage if accessible, with an exception of tuberculous brain abscess which is treated with anti-tuberculous agents.

  • Antibiotics: Brain abscesses are usually polymicrobial, with the most common bugs being microaerophilic streptococci (viridans) and anaerobic bacteria (bacteroides, anaerobic strep and fusobacterium).
  • Even if the abscess is associated with a dental procedure and other organisms are considered (actinomyces sp.) they generally respond to the above Rx.
  • If extending from an otitis, empiric Rx should also cover pseudomonas and enterobacteriacaea.
  • If hematogenously spread, coverage depends on the original bug.
  • The penetration of abx into an abscess does not necessarily equate with their penetration into the CSF (the blood-brain barrier is not the same as the blood-CSF barrier).
  • Drugs like vancomycin, which have poor CSF levels (<10% of serum) have been shown to have good abscess levels (90% of serum).
  • Most patients are treated parenterally for at least 8w.
  • Some authors also recommend an additional 2 – 3 month course of oral abx to clear up any ‘residual’ infection and to prevent relapses.
  • One study actually suggests that, when combined with surgical excision, 3w may be adequate.
  • Other studies have reported good outcomes with abx alone in patients with small lesions (<2cm), in well vascularized areas (cortex), who were poor surgical candidates.
  • There have not been any studies reporting benefit from intra-thecal or intra-abscess abx.
  • There seems to be consensus on obtaining q 2 – 4w f/u CT/MRI scans to document resolution.

Adjuvants

  • Although steroids have not been studies in well-designed trials, many authors use them in patients with elevated ICP.
  • Some animal studies suggest interference with granulation tissue formation and bacterial clearance.
  • Anticonvulsants are recommended prophylactically for the 1st 3m, though the data supporting this is lacking.[1]

Antimicrobial Regimen

Brain abscess

  • Empiric antimicrobial therapy[2][3]
Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
  • Brain abscess in otherwise healthy patients
  • Brain abscess with comorbidities
  • Otitis media, mastoiditis, or sinusitis
  • Dental infection
  • Penetrating trauma or post-neurosurgy
  • Lung abscess, empyema, or bronchiectasis
  • Bacterial endocarditis
  • Congenital heart disease
  • Transplant recipients
  • Patients with HIV/AIDS
  • Staphylococcus aureus coverage
  • Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h
  • Mycobacterium tuberculosis coverage
  • Pathogen-directed antimicrobial therapy[4][5][6]
Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
  • Bacteria
  • Actinomyces
  • Bacteroides fragilis
  • Enterobacteriaceae
  • Fusobacterium
  • Haemophilus
  • Listeria monocytogenes
  • Nocardia
  • Prevotella melaninogenica
  • Pseudomonas aeruginosa
  • 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.
  • Staphylococcus aureus, methicillin-susceptible (MSSA)
  • Streptococcus
  • Fungi
  • Aspergillus
  • Candida
  • Cryptococcus neoformans
  • Mucorales
  • Pseudallescheria boydii (Scedosporium apiospermum)
  • Protozoa
  • Toxoplasma gondii

References

  1. ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
  2. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  3. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  4. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  5. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  6. ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
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