Community-acquired Brain Abscess
- Urgent Micro/ID consult
- Urgent biopsy and drainage with collection of specimens for culture is considered optimal management to ensure source control of brain abscess.
- Modify treatment according to sensitivity test results.
- HIV testing is indicated
If post neurosurgical infection see Meningitis: post-neurosurgical infection
Treat for 4-6 weeks (initial 2-4 weeks IV then PO conversion). Once source control is achieved with aspiration or surgical drainage oral conversion can be considered.
Some difficult to treat cases might require longer treatment. Always discuss with Micro/ID.
Preferred empiric treatment
Includes penicillin allergy (non-severe)
ceftriaxone 2g iv bd
AND
metronidazole 400mg po tds (or 500mg iv tds)
For MRSA positive patients: ADD linezolid 600mg po bd (iv if NBM) (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with vancomycin iv
Once culture and sensitivity available see section below.
See below for oral follow on
Alternative empiric treatment
For penicillin allergy (severe)
moxifloxacin* 400mg po od (iv if NBM)
Moxifloxacin may induce convulsions in patients with or without a history of convulsions – use with caution
For MRSA positive patients: ADD linezolid 600mg po bd (iv if NBM) (See linezolid drug monograph for information about monitoring required)
If unable to have linezolid: substitute linezolid with vancomycin iv
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including moxifloxacin, are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.
See below for oral follow on
Once culture and sensitivity available
Discuss with Micro/ID.
If cultures show penicillin susceptible streptococcus spp and there is no penicillin allergy then step down to:
amoxicillin 1g iv tds OR benzylpenicillin 2.4g iv 4-6 hourly
See below for oral follow on
Oral follow-on
Always discuss oral options with Micro ID; selection will be determined by culture results and susceptibilities, as well as history of penicillin allergy. Options include:
amoxicillin 1g po tds
OR
co-trimoxazole 960mg po bd
OR
linezolid 600mg po bd (See linezolid drug monograph for information about monitoring required)
OR
chloramphenicol 12.5mg/kg po qds (maximum 4g in 24 hours round to nearest 250mg capsule). Use adjusted body weight to calculate dose if actual body weight is greater than 20% of ideal body weight.
OR
moxifloxacin* 400mg po od. (Moxifloxacin may induce convulsions in patients with or without a history of convulsions – use with caution)
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including moxifloxacin, are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.