Sandbox brain abscess: Difference between revisions

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==Antimicrobial Therapy – Empiric Therapy==
==Antimicrobial Therapy – Empiric Therapy==
{{rx|Preferred regimen}}
{{rx|Preferred regimen}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} </li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
{{rx|Alternative regimen}}
{{rx|Alternative regimen}}
<li>[[Meropenem]] 6 g/day q8h</li>
* [[Meropenem]] 6 g/day q8h
</ul>
</li>
{{rx|Transplant recipients}}
{{rx|Transplant recipients}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} </li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
<li>[[Metronidazole]] 30 mg/kg/day q6h {{and}} </li>
* [[Metronidazole]] 30 mg/kg/day q6h {{and}}
<li>[[Voriconazole]] 8 mg/kg/day q12h {{and}} </li>
* [[Voriconazole]] 8 mg/kg/day q12h {{and}}
<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h</li>
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
</ul>
</li>
{{rx|Patients with HIV/AIDS}}
{{rx|Patients with HIV/AIDS}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}} </li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h {{and}}
<li>[[Sulfadiazine]] 4–6 g/day q6h {{and}} </li>
* [[Sulfadiazine]] 4–6 g/day q6h {{and}}
<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
* [[Pyrimethamine]] 25–100 mg/day qd
</ul>
</li>
{{rx|Staphylococcus aureus coverage}}
{{rx|Staphylococcus aureus coverage}}
<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</ul>
</li>
{{rx|Mycobacterium tuberculosis coverage}}
{{rx|Mycobacterium tuberculosis coverage}}
<li>[[Isoniazid]] 300 mg qd {{and}} </li>
* [[Isoniazid]] 300 mg qd {{and}}
<li>[[Rifampin]] 600 mg qd {{and}} </li>
* [[Rifampin]] 600 mg qd {{and}}
<li>[[Pyrazinamide]] 15–30 mg qd {{and}} </li>
* [[Pyrazinamide]] 15–30 mg qd {{and}}
<li>[[Ethambutol]] 15 mg/kg/day qd</li>
* [[Ethambutol]] 15 mg/kg/day qd
</ul>
</li>


==Antimicrobial Therapy – Pathogen-Based Therapy==
==Antimicrobial Therapy – Pathogen-Based Therapy==
{{rx|Actinomyces}}
{{rx|Actinomyces}}
<li>[[Penicillin G]] 24 MU q4h</li>
* [[Penicillin G]] 24 MU q4h
</ul>
</li>
{{rx|Bacteroides fragilis}}
{{rx|Bacteroides fragilis}}
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
{{rx|Enterobacteriaceae}}
{{rx|Enterobacteriaceae}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h</li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
</ul>
</li>
{{rx|Fusobacterium}}
{{rx|Fusobacterium}}
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
{{rx|Haemophilus}}
{{rx|Haemophilus}}
<li>[[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h</li>
* [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Ceftriaxone]] 4 g/day q12h
</ul>
</li>
{{rx|Listeria monocytogenes}}
{{rx|Listeria monocytogenes}}
<li>[[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h</li>
* [[Ampicillin]] 12 g/day q4h {{or}} [[Penicillin G]] 24 MU q4h
</ul>
</li>
{{rx|Nocardia}}
{{rx|Nocardia}}
<li>[[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h</li>
* [[TMP-SMZ]] 10–20 mg/kg/day q6–12h {{or}} [[Sulfadiazine]] 4–6 g/day q6h
</ul>
</li>
{{rx|Prevotella melaninogenica}}
{{rx|Prevotella melaninogenica}}
<li>[[Metronidazole]] 30 mg/kg/day q6h</li>
* [[Metronidazole]] 30 mg/kg/day q6h
</ul>
</li>
{{rx|Pseudomonas aeruginosa}}
{{rx|Pseudomonas aeruginosa}}
<li>[[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h</li>
* [[Ceftazidime]] 6 g/day q8h {{or}} [[Cefepime]] 6 g/day q8h
</ul>
</li>
{{rx|Methicillin-sensitive Staphylococcus aureus}}
{{rx|Methicillin-sensitive Staphylococcus aureus}}
<li>[[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h</li>
* [[Nafcillin]] 12 g/day q4h {{or}} [[Oxacillin]] 12 g/day q4h
</ul>
</li>
{{rx|Methicillin-resistant Staphylococcus aureus}}
{{rx|Methicillin-resistant Staphylococcus aureus}}
<li>[[Vancomycin]] 30–45 mg/kg/day q8–12h</li>
* [[Vancomycin]] 30–45 mg/kg/day q8–12h
</ul>
</li>
{{rx|Streptococcus anginosus and other streptococci}}
{{rx|Streptococcus anginosus and other streptococci}}
<li>[[Penicillin G]] 24 MU q4h</li>
* [[Penicillin G]] 24 MU q4h
</ul>
</li>
{{rx|Aspergillus}}
{{rx|Aspergillus}}
<li>[[Voriconazole]] 8 mg/kg/day q12h</li>
* [[Voriconazole]] 8 mg/kg/day q12h
</ul>
</li>
{{rx|Candida}}
{{rx|Candida}}
<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</ul>
</li>
{{rx|Cryptococcus neoformans}}
{{rx|Cryptococcus neoformans}}
<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</ul>
</li>
{{rx|Mucorales}}
{{rx|Mucorales}}
<li>[[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h</li>
* [[Amphotericin B]] lipid complex 5 mg/kd/day q24h {{or}} [[Amphotericin B]] deoxycholate 15 mg/kg/day q8h
</ul>
</li>
{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}}
{{rx|Pseudallescheria boydii (Scedosporium apiospermum)}}
<li>[[Voriconazole]] 8 mg/kg/day q12h</li>
* [[Voriconazole]] 8 mg/kg/day q12h
</ul>
</li>
{{rx|Toxoplasma gondii}}
{{rx|Toxoplasma gondii}}
<li>[[Sulfadiazine]] 4–6 g/day q6h {{and}} </li>
* [[Sulfadiazine]] 4–6 g/day q6h {{and}}
<li>[[Pyrimethamine]] 25–100 mg/day qd</li>
* [[Pyrimethamine]] 25–100 mg/day qd
</ul>
</li>


==References==
==References==

Revision as of 03:35, 19 April 2015


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

    • Antimicrobial Therapy – Pathogen-Based Therapy

    • References

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