Post surgical brain abscess/empyema

Required investigations

Blood cultures X 2 sets (10mls in each bottle)

Surgical drainage if possible is key.

Antibiotic recommendation

Recommended antibiotic

Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L

PLUS

Ceftazidime 2g IV 8 hourly

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)*

Severe penicillin allergy

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)*

*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.

Recommended total duration

Discuss with microbiology and neurosurgery

Conservative management or aspirated lesions: 6-8 weeks 

Notes

Causative organisms in post-neurosurgical brain abscess include Staph aureus and Gram-negative organisms.