Base empiric therapy on presumed source of abscess and Gram stain results
Source: mouth, ear, sinus
- [Penicillin (mouth) OR cefotaxime (ear/sinus)] + [metronidazole]
Source: neurosurgery / post-op
- [ceftazidime OR cefepime OR meropenem OR imipenem] + [vancomycin]
Source: penetrating trauma
- [ceftriaxone or cefotaxime] + [vancomycin] +/- [metronidazole (sinus involvement)]
Source: hematogenous spread (IE, multiple abscess)
- [ceftriaxone or cefotaxime] + [vancomycin] + [metronidazole]
Source: unknown
- [ceftriaxone or cefotaxime] + [vancomycin] + [metronidazole]
Dosages:
- Cefepime 2g IV q8h
- Cefotaxime 2g IV q4-6h
- Ceftriaxone 2g IV q12h
- Ceftazidime 2g IV q8h
- Imipenem 500-1000mg q6h
- Meropenem 2g IV q8h
- Metronidazole 15mg/kg IV load then 7.5mg/kg IV q8h; usually 1G load & 500mg q8h
- Nafcililn 2g IV q4h
- Oxacillin 2g IV q4h
- Penicillin G 20-24 M units / day IV in 6 divided doses
- Vancomycin 15-20mg/Kg IV q8-12h
Reference:
Uptodate: Treatment and prognosis of bacterial brain abscess, accessed 01/10/2017.
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Peripheral Brain 