Antimicrobial prescribing: NHS Lothian
Blood cultures X 2 sets (10mls in each bottle)
Surgical drainage if possible is key and samples should be obtained prior to antibiotic initiation in stable patients
Cerebral abscess/subdural empyema
| Recommended antibiotic |
Ceftriaxone 2g IV 12 hourly* PLUS Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)** If MRSA positive ADD Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L |
|
Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L PLUS Ciprofloxacin 400mg IV 8 hourly *** PLUS Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)** |
*Use Ceftazidime 2g IV 8 hourly instead of Ceftriaxone in cases at increased risk of pseudomonal brain abscess (e.g. chronic suppurative otitis media and extensive prior antibiotic treatment, or if diabetic).
**Maximum duration of metronidazole should be 4 weeks unless indicated by infection specialist due to the risk of neuropathy
***Avoid fluoroquinolones if taking steroids and the elderly. Review MHRA Quinolone Warning before prescribing. If an alternative agent is required, please contact microbiology.
Discuss with microbiology and neurosurgery
Conservative management or aspirated lesions: 6-8 weeks
Surgically treated abscess: shorter duration may be considered (e.g. 4 weeks)
- Seek advice from infection specialist if immunocompromised.
- In many cases of community onset cerebral abscess there may be a contiguous site of infection such as a dental abscess, sinusitis or mastoiditis.
- Common organisms include: Streptococci spp, anaerobes such as Fusobacterium spp or Bacteroides.