2.1 Brain Abscess
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Uncomplicated (abscess < 2.5cm & patient neurologically stable) | Ceftriaxone 2g IV q12h Or Cefotaxime 2g IV q6h + Metronidazole 500mgIV q8h (10 mg/kg/dose) | Inj Meropenem 2g IV q8h In case of allergy to penicillins, cephalosporins and carbapenems antibiotics: Vancomycin 1g IV q12h + Aztreonam IV 2g q8h | To exclude TB, Nocardia, Aspergillus, Mucor, Cladophialophora, Candida, Cryptococcus neoformans, Entamoeba histolytica, Listeria monocytogenes. Duration of treatment: 3- 12 weeks (depending on resolution of lesions and symptoms. |
| Complicated (Patient neurologically unstable) | Meropenem 2g IV q8h + Vancomycin 25 mg/kg IV stat followed by 15mg/kg q 8-12h | Drain pus, rationalize antibiotics according to culture and sensitivity and continue for 3 to 12 weeks. |
For common etiological agents of Brain Abscess, see Annexure B.2.1
Additional Information
- If abscess >2.5cm consider aspiration/surgical drainage and modify antibiotics as per sensitivity of aspirated/drained secretions.
References
1. Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC; ESCMID Study Group for Infections of the Brain (ESGIB). European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024 Jan;30(1):66-89. doi: 10.1016/j.cmi.2023.08.016. Epub 2023 Aug 29. Erratum in: Clin Microbiol Infect. 2024 May;30(5):698. doi: 10.1016/j.cmi.2024.01.026. PMID: 37648062. https://idmp.ucsf.edu/content/intracranial-abscess