13. 9
:
4
.
.
.
)
(
-
:
shift of midline to the opposite side
)
3(
Vancomycin
)
2 ( Brain abscess Ring enhanced lesion in Rt Parietal lobe Infarction of the adjacent Brain parenchyma
)
1(
MRI
CT +3rd generalize of cephalosporine + Metronidazol + )
3(
Aspiration abcess
14. When the cause is unknown, the combination of vancomycin, a 3rdgeneration cephalosporin, and metronidazole is commonly used.
The same regimen is initiated when otitis media, sinusitis, or
mastoiditis is the likely cause.
If there is a history of penetrating head injury, head trauma, or
neurosurgery, vancomycin plus a 3rd-generation cephalosporin is
appropriate.
When cyanotic congenital heart disease is the predisposing factor,
ampicillin-sulbactam alone or a 3rd-generation cephalosporin plus
metronidazole may be used.
Meropenem has good activity against gram-negative bacilli,
anaerobes, staphylococci, and streptococci, including most
antibiotic-resistant pneumococci, and may be used alone to replace
the combination of metronidazole and a β-lactam in the previous
regimens.
15. Notably, meropenem does not provide activity against methicillinresistant S. aureus and may have decreased activity against
penicillin-resistant strains of S. pneumoniae, indicating that
vancomycin should remain a part of the initial regimen when these
organisms are suspected.
Abscesses secondary to an infected ventriculoperitoneal shunt may be
initially treated with vancomycin and ceftazidime.
When Citrobacter meningitis (often in neonates) leads to abscess
formation, a 3rd-generation cephalosporin is used, typically in
combination with an aminoglycoside.
Listeria monocytogenes may cause a brain abscess in the neonate and
if suspected, ampicillin should be added to the cephalosporin.
In immunocompromised patients, broad-spectrum antibiotic coverage
is used, and amphotericin B therapy should be considered.
16. •
•
•
•
•
•
•
•
•
•
•
•
without surgery if
the abscess is <2 cm in diameter,
the illness is of short duration (<2 wk),
there are no signs of increased intracranial pressure, and
the child is neurologically intact.
Surgery
when the abscess is >2.5 cm in diameter,
gas is present in the abscess,
the lesion is multiloculated,
the lesion is located in the posterior fossa, or
a fungus is identified.
Associated infectious processes, such as mastoiditis, sinusitis, or a
periorbital abscess, may require surgical drainage.
• The duration of antibiotic therapy depends on the organism and
response to treatment, but is usually 4-6 wk.
