Brain abscess

Consult Paediatric ID

Urgent biopsy with collection of specimen for culture recommended for most lesions.

Modify treatment according to susceptibility results.

Can be converted to IV ceftriaxone once daily and oral metronidazole when the patient has improved (with view to OPAT).

Patient may be converted to oral after 2 weeks, if: 1) abscess drained, 2) good clinical response and 3) organism and sensitivities known.

Open all

ceftriaxone 100mg/kg (Max 4g) iv OD

AND metronidazole iv see dosing table below

ADD vancomycin iv if trauma or infection following neurosurgical procedure

metronidazole IV dosing information:

Age	metronidazole IV dose
1 month up to 2 months	Loading dose 15 mg/kg (Max 500mg) iv, then (after 8 hours) 7.5 mg/kg (Max 500mg) iv TDS
2 months to 17 years	7.5mg/kg (Max 500mg) iv TDS

For severe penicillin allergy

ciprofloxacin* 10mg/kg (Max 400mg) iv TDS

AND metronidazole iv see dosing table below

AND vancomycin iv

metronidazole IV dosing information:

Age	metronidazole IV dose
1 month up to 2 months	Loading dose 15 mg/kg (Max 500mg) iv, then (after 8 hours) 7.5 mg/kg (Max 500mg) iv TDS
2 months to 17 years	7.5mg/kg (Max 500mg) iv TDS

* Note: Ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution.

Also Note: If patient is prescribed ciprofloxacin ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet.

For more information about MHRA safety alerts and patient or carer counselling See Fluoroquinolone antibiotics - paediatric position statement

Last reviewed: 01 Dec 2023

Author(s): AMST.

Approved By: MMTC

Preferred including non-severe penicillin allergy