Sandbox brain abscess

# Overview
Treatment of brain abscess requires a multidisciplinary approach to delineate extent of infection, plan stereotactic trajectory, aspirate purulent materials, lower intracranial pressure, identify causative pathogen, and administer appropriate antibiotics.

# Antimicrobial Therapy  Empiric Therapy
- Preferred regimen
Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h AND
Metronidazole 30 mg/kg/day q6h
- Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h AND
- Metronidazole 30 mg/kg/day q6h
- Alternative regimen
Meropenem 6 g/day q8h
- Meropenem 6 g/day q8h
- Transplant recipients
Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h AND
Metronidazole 30 mg/kg/day q6h AND
Voriconazole 8 mg/kg/day q12h AND
TMP-SMZ 1020 mg/kg/day q612h OR Sulfadiazine 46 g/day q6h
- Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h AND
- Metronidazole 30 mg/kg/day q6h AND
- Voriconazole 8 mg/kg/day q12h AND
- TMP-SMZ 1020 mg/kg/day q612h OR Sulfadiazine 46 g/day q6h
- Patients with HIV/AIDS
Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h AND
Sulfadiazine 46 g/day q6h AND
Pyrimethamine 25100 mg/day qd
- Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h AND
- Sulfadiazine 46 g/day q6h AND
- Pyrimethamine 25100 mg/day qd
- Staphylococcus aureus coverage
Vancomycin 3045 mg/kg/day q812h
- Vancomycin 3045 mg/kg/day q812h
- Mycobacterium tuberculosis coverage
Isoniazid 300 mg qd AND
Rifampin 600 mg qd AND
Pyrazinamide 1530 mg qd AND
Ethambutol 15 mg/kg/day qd
- Isoniazid 300 mg qd AND
- Rifampin 600 mg qd AND
- Pyrazinamide 1530 mg qd AND
- Ethambutol 15 mg/kg/day qd

# Antimicrobial Therapy  Pathogen-Based Therapy
- Actinomyces
Penicillin G 24 MU q4h
- Penicillin G 24 MU q4h
- Bacteroides fragilis
Metronidazole 30 mg/kg/day q6h
- Metronidazole 30 mg/kg/day q6h
- Enterobacteriaceae
Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h
- Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h
- Fusobacterium
Metronidazole 30 mg/kg/day q6h
- Metronidazole 30 mg/kg/day q6h
- Haemophilus
Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h
- Cefotaxime 812 g/day q46h OR Ceftriaxone 4 g/day q12h
- Listeria monocytogenes
Ampicillin 12 g/day q4h OR Penicillin G 24 MU q4h
- Ampicillin 12 g/day q4h OR Penicillin G 24 MU q4h
- Nocardia
TMP-SMZ 1020 mg/kg/day q612h OR Sulfadiazine 46 g/day q6h
- TMP-SMZ 1020 mg/kg/day q612h OR Sulfadiazine 46 g/day q6h
- Prevotella melaninogenica
Metronidazole 30 mg/kg/day q6h
- Metronidazole 30 mg/kg/day q6h
- Pseudomonas aeruginosa
Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h
- Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h
- Methicillin-sensitive Staphylococcus aureus
Nafcillin 12 g/day q4h OR Oxacillin 12 g/day q4h
- Nafcillin 12 g/day q4h OR Oxacillin 12 g/day q4h
- Methicillin-resistant Staphylococcus aureus
Vancomycin 3045 mg/kg/day q812h
- Vancomycin 3045 mg/kg/day q812h
- Streptococcus anginosus and other streptococci
Penicillin G 24 MU q4h
- Penicillin G 24 MU q4h
- Aspergillus
Voriconazole 8 mg/kg/day q12h
- Voriconazole 8 mg/kg/day q12h
- Candida
Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Cryptococcus neoformans
Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Mucorales
Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Amphotericin B lipid complex 5 mg/kd/day q24h OR Amphotericin B deoxycholate 15 mg/kg/day q8h
- Pseudallescheria boydii (Scedosporium apiospermum)
Voriconazole 8 mg/kg/day q12h
- Voriconazole 8 mg/kg/day q12h
- Toxoplasma gondii
Sulfadiazine 46 g/day q6h AND
Pyrimethamine 25100 mg/day qd
- Sulfadiazine 46 g/day q6h AND
- Pyrimethamine 25100 mg/day qd