Cerebral abscess

Case Definition:

Intracranial abscess, extradural, subdural and cerebral abscesses can occur as a complication of suppurative otitis media. (Note: For post-surgical infections or penetrating injury or immunocompromised, discuss with Consultant Microbiologist).

 

Diagnostic criteria:

Neurological signs, headache, vomiting, swinging pyrexia and altered state of consciousness in a patient with acute suppurative otitis media or acute mastoiditis. CT and or MRI needed to confirm the diagnosis, advice from neurosurgical unit is mandatory. If the source of the infection is unclear (no evidence of ENT infection)  then an alternative source e.g.bacterial endocarditis needs to be considered. Dicuss with consultant microbiologist.

 

Specimens to be collected:

  • Blood cultures

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)
A/B/C

Minor to severe life threatening infection 

Review doses in renal impairment

CEFTRIAXONE 2g iv bd
Plus
METRONIDAZOLE 400mg po tds

 

Add

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg

50-100kg: 600mg

>100kg: 800mg 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 20-60mg/L.

(Note: For post-surgical infections or penetrating injury or immunocompromised, discuss with Consultant Microbiologist).

IV antibiotics typically needed for 6 to 8 weeks unless surgical drainage. Discuss with Microbiology for possibility of continued oral antibiotic therapy.

Severe Penicillin Allergy:

Discuss with Consultant Microbiologist

 

 

 

 

 

 

 

 

 

 

IV antibiotics typically needed for 6 to 8 weeks unless surgical drainage. Discuss with Microbiology for possibility of continued oral antibiotic therapy.

IV to Oral Switch (explanatory notes

Oral switch not appropriate before 6 weeks
Discuss with Consultant Microbiologist

Oral switch not appropriate before 6 weeks
Discuss with Consultant Microbiologist

Last reviewed 23/04/14

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)