Template:ID-Septic thrombosis of cavernous or dural venous sinus: Difference between revisions
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* Septic thrombosis of cavernous or dural venous sinus | *Cavernous sinus thrombosis is considered a medical emergency. | ||
*Duration of therapy is usually a total of 3-4 weeks. More prolonged administration of antimicrobial therapy (total of 6-8 weeks) may be indicated among patients who are suspected to have developed complications (e.g. suppurative intracranial disease). | |||
*ENT surgery must be consulted to evaluate the need of surgical drainage (e.g. sphenoidotomy if sphenoid sinus infection is the primary cause). | |||
* '''Septic thrombosis of cavernous or dural venous sinus''' | |||
:*1. '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1161/STR.0b013e31820a8364| issn = 1524-4628| volume = 42| issue = 4| pages = 1158–1192| last1 = Saposnik| first1 = Gustavo| last2 = Barinagarrementeria| first2 = Fernando| last3 = Brown| first3 = Robert D.| last4 = Bushnell| first4 = Cheryl D.| last5 = Cucchiara| first5 = Brett| last6 = Cushman| first6 = Mary| last7 = deVeber| first7 = Gabrielle| last8 = Ferro| first8 = Jose M.| last9 = Tsai| first9 = Fong Y.| last10 = American Heart Association Stroke Council and the Council on Epidemiology and Prevention| title = Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association| journal = Stroke; a Journal of Cerebral Circulation| date = 2011-04| pmid = 21293023}}</ref><ref>{{Cite journal| issn = 0003-9926| volume = 161| issue = 22| pages = 2671–2676| last1 = Ebright| first1 = J. R.| last2 = Pace| first2 = M. T.| last3 = Niazi| first3 = A. F.| title = Septic thrombosis of the cavernous sinuses| journal = Archives of Internal Medicine| date = 2001-12-10| pmid = 11732931}}</ref><ref>{{Cite journal| issn = 0022-2151| volume = 107| issue = 9| pages = 803–808| last = Singh| first = B.| title = The management of lateral sinus thrombosis| journal = The Journal of Laryngology and Otology| date = 1993-09| pmid = 8228594}}</ref><ref>{{Cite journal| issn = 0025-7974| volume = 65| issue = 2| pages = 82–106| last1 = Southwick| first1 = F. S.| last2 = Richardson| first2 = E. P.| last3 = Swartz| first3 = M. N.| title = Septic thrombosis of the dural venous sinuses| journal = Medicine| date = 1986-03| pmid = 3512953}}</ref> | :*1. '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1161/STR.0b013e31820a8364| issn = 1524-4628| volume = 42| issue = 4| pages = 1158–1192| last1 = Saposnik| first1 = Gustavo| last2 = Barinagarrementeria| first2 = Fernando| last3 = Brown| first3 = Robert D.| last4 = Bushnell| first4 = Cheryl D.| last5 = Cucchiara| first5 = Brett| last6 = Cushman| first6 = Mary| last7 = deVeber| first7 = Gabrielle| last8 = Ferro| first8 = Jose M.| last9 = Tsai| first9 = Fong Y.| last10 = American Heart Association Stroke Council and the Council on Epidemiology and Prevention| title = Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association| journal = Stroke; a Journal of Cerebral Circulation| date = 2011-04| pmid = 21293023}}</ref><ref>{{Cite journal| issn = 0003-9926| volume = 161| issue = 22| pages = 2671–2676| last1 = Ebright| first1 = J. R.| last2 = Pace| first2 = M. T.| last3 = Niazi| first3 = A. F.| title = Septic thrombosis of the cavernous sinuses| journal = Archives of Internal Medicine| date = 2001-12-10| pmid = 11732931}}</ref><ref>{{Cite journal| issn = 0022-2151| volume = 107| issue = 9| pages = 803–808| last = Singh| first = B.| title = The management of lateral sinus thrombosis| journal = The Journal of Laryngology and Otology| date = 1993-09| pmid = 8228594}}</ref><ref>{{Cite journal| issn = 0025-7974| volume = 65| issue = 2| pages = 82–106| last1 = Southwick| first1 = F. S.| last2 = Richardson| first2 = E. P.| last3 = Swartz| first3 = M. N.| title = Septic thrombosis of the dural venous sinuses| journal = Medicine| date = 1986-03| pmid = 3512953}}</ref> | ||
::* Preferred regimen: ([[Nafcillin]] 2 g IV q4h for 3-4 weeks {{or}} [[Oxacillin]] 2 g IV q4h 3-4 weeks) {{and}} ([[Ceftriaxone]] 2 g IV q12h 3-4 weeks {{or}} [[Cefotaxime]] 8–12 g/day IV q4–6h 3-4 weeks) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h 3-4 weeks | ::* Preferred regimen: ([[Vancomycin]] 30–45 mg/kg IV q8–12h for 3-4 weeks {{or}} [[Nafcillin]] 2 g IV q4h for 3-4 weeks {{or}} [[Oxacillin]] 2 g IV q4h for 3-4 weeks) {{and}} ([[Ceftriaxone]] 2 g IV q12h for 3-4 weeks {{or}} [[Cefotaxime]] 8–12 g/day IV q4–6h for 3-4 weeks) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h 3-4 weeks | ||
::: Note (1): If risk of MRSA is high, [[Vancomycin]] | ::: Note (1): If risk of MRSA is high, [[Vancomycin]] should be administered instead of either nafcillin or oxacillin | ||
::: Note (2): The optimal duration of therapy remains unclear | ::: Note (2): The optimal duration of therapy remains unclear | ||
:*2. '''Specific anatomic considerations''' | :*2. '''Specific anatomic considerations''' | ||
::*2.1 '''Cavernous sinus''' | ::*2.1 '''Cavernous sinus''' | ||
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg IV q8–12h 3-4 weeks {{and}} ([[Ceftriaxone]] 2 g IV q12h 3-4 weeks {{or}} [[Cefotaxime]] 8–12 g/day IV q4–6h 3-4 weeks) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h 3-4 weeks | :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg IV q8–12h for 3-4 weeks {{and}} ([[Ceftriaxone]] 2 g IV q12h for 3-4 weeks {{or}} [[Cefotaxime]] 8–12 g/day IV q4–6h for 3-4 weeks) {{and}} [[Metronidazole]] 7.5 mg/kg IV q6h for 3-4 weeks | ||
:::: Note: [[Daptomycin]] 8–12 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV q12h could be considered for patients unable to tolerate vancomycin | :::: Note: [[Daptomycin]] 8–12 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV q12h could be considered for patients unable to tolerate vancomycin | ||
::*2.2 '''Lateral sinus''' | ::*2.2 '''Lateral sinus''' | ||
:::* Preferred regimen: [[Cefepime]] 2 g IV q8h 3-4 weeks {{and}} [[Metronidazole]] 500 mg IV q8h 3-4 weeks {{and}} [[Vancomycin]] 15-20 IV mg/kg 3-4 weeks | :::* Preferred regimen: [[Cefepime]] 2 g IV q8h for 3-4 weeks {{and}} [[Metronidazole]] 500 mg IV q8h for 3-4 weeks {{and}} [[Vancomycin]] 15-20 IV mg/kg for 3-4 weeks | ||
:::* Alternative regimen: [[Meropenem]] 1-2 g IV q8h 3-4 weeks {{and}} [[Linezolid]] 600 mg IV q12h 3-4 weeks | :::* Alternative regimen: [[Meropenem]] 1-2 g IV q8h 3-4 weeks {{and}} [[Linezolid]] 600 mg IV q12h 3-4 weeks | ||
::*2.3 '''Superior sagittal sinus''' | ::*2.3 '''Superior sagittal sinus''' | ||
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q12h 3-4 weeks {{and}} [[Vancomycin]] 15–20 mg/kg 3-4 weeks {{and}} [[Dexamethasone]] | :::* Preferred regimen: [[Ceftriaxone]] 2 g IV q12h for 3-4 weeks {{and}} [[Vancomycin]] 15–20 mg/kg for 3-4 weeks {{and}} [[Dexamethasone]] 10 mg IV q6h continued until symptomatic improvement and tailed gradually over several weeks | ||
:::* Alternative regimen: [[Meropenem]] 1–2 g IV q8h 3-4 weeks {{and}} [[Vancomycin]] 15–20 mg/kg 3-4 weeks {{and}} [[Dexamethasone]] | :::* Alternative regimen: [[Meropenem]] 1–2 g IV q8h for 3-4 weeks {{and}} [[Vancomycin]] 15–20 mg/kg for 3-4 weeks {{and}} [[Dexamethasone]] 10 mg IV q6h continued until symptomatic improvement and tailed gradually over several weeks | ||
:*3. '''Pathogen-directed antimicrobial therapy''' | :*3. '''Pathogen-directed antimicrobial therapy''' |
Latest revision as of 19:39, 6 October 2015
- Cavernous sinus thrombosis is considered a medical emergency.
- Duration of therapy is usually a total of 3-4 weeks. More prolonged administration of antimicrobial therapy (total of 6-8 weeks) may be indicated among patients who are suspected to have developed complications (e.g. suppurative intracranial disease).
- ENT surgery must be consulted to evaluate the need of surgical drainage (e.g. sphenoidotomy if sphenoid sinus infection is the primary cause).
- Septic thrombosis of cavernous or dural venous sinus
-
- Preferred regimen: (Vancomycin 30–45 mg/kg IV q8–12h for 3-4 weeks OR Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks) AND (Ceftriaxone 2 g IV q12h for 3-4 weeks OR Cefotaxime 8–12 g/day IV q4–6h for 3-4 weeks) AND Metronidazole 7.5 mg/kg IV q6h 3-4 weeks
- Note (1): If risk of MRSA is high, Vancomycin should be administered instead of either nafcillin or oxacillin
- Note (2): The optimal duration of therapy remains unclear
- 2. Specific anatomic considerations
- 2.1 Cavernous sinus
- Preferred regimen: Vancomycin 30–45 mg/kg IV q8–12h for 3-4 weeks AND (Ceftriaxone 2 g IV q12h for 3-4 weeks OR Cefotaxime 8–12 g/day IV q4–6h for 3-4 weeks) AND Metronidazole 7.5 mg/kg IV q6h for 3-4 weeks
- Note: Daptomycin 8–12 mg/kg IV q24h OR Linezolid 600 mg IV q12h could be considered for patients unable to tolerate vancomycin
- 2.2 Lateral sinus
- Preferred regimen: Cefepime 2 g IV q8h for 3-4 weeks AND Metronidazole 500 mg IV q8h for 3-4 weeks AND Vancomycin 15-20 IV mg/kg for 3-4 weeks
- Alternative regimen: Meropenem 1-2 g IV q8h 3-4 weeks AND Linezolid 600 mg IV q12h 3-4 weeks
- 2.3 Superior sagittal sinus
- Preferred regimen: Ceftriaxone 2 g IV q12h for 3-4 weeks AND Vancomycin 15–20 mg/kg for 3-4 weeks AND Dexamethasone 10 mg IV q6h continued until symptomatic improvement and tailed gradually over several weeks
- Alternative regimen: Meropenem 1–2 g IV q8h for 3-4 weeks AND Vancomycin 15–20 mg/kg for 3-4 weeks AND Dexamethasone 10 mg IV q6h continued until symptomatic improvement and tailed gradually over several weeks
- 3. Pathogen-directed antimicrobial therapy
- Staphylococcus aureus, methicillin-resistant (MRSA)[5]
- Preferred regimen: Vancomycin 15–20 mg/kg/dose 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 4–6 weeks OR Linezolid 10 mg/kg/dose PO/IV q8h 4–6 weeks
- Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible
- Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin
- ↑ Saposnik, Gustavo; Barinagarrementeria, Fernando; Brown, Robert D.; Bushnell, Cheryl D.; Cucchiara, Brett; Cushman, Mary; deVeber, Gabrielle; Ferro, Jose M.; Tsai, Fong Y.; American Heart Association Stroke Council and the Council on Epidemiology and Prevention (2011-04). "Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association". Stroke; a Journal of Cerebral Circulation. 42 (4): 1158–1192. doi:10.1161/STR.0b013e31820a8364. ISSN 1524-4628. PMID 21293023. Check date values in:
|date=
(help) - ↑ Ebright, J. R.; Pace, M. T.; Niazi, A. F. (2001-12-10). "Septic thrombosis of the cavernous sinuses". Archives of Internal Medicine. 161 (22): 2671–2676. ISSN 0003-9926. PMID 11732931.
- ↑ Singh, B. (1993-09). "The management of lateral sinus thrombosis". The Journal of Laryngology and Otology. 107 (9): 803–808. ISSN 0022-2151. PMID 8228594. Check date values in:
|date=
(help) - ↑ Southwick, F. S.; Richardson, E. P.; Swartz, M. N. (1986-03). "Septic thrombosis of the dural venous sinuses". Medicine. 65 (2): 82–106. ISSN 0025-7974. PMID 3512953. Check date values in:
|date=
(help) - ↑ 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.