treatment

Last reviewed 01/2018

Classically the treatment is by drainage, culture and antibiotic administration.

Antibiotics:

• should be used in
  • multiple abscesses
  • abscesses located deep inside the brain (1)
• consult bacteriologist re: appropriate antibiotics. Blind therapy may involve ceftazidime (cover gram +ve's and gram -ve's), metronidazole (cover anaerobes) and flucloxacillin (cover staphylococcus aureus)
• switch to more specific treatments once organisms identified

Abscess drainage:

• primary excision of whole abscess - standard for cerebellar abscess; risk of damage to surrounding brain tissue
• burr hole aspiration - simple, safe, may need repeating
• open evacuation - involves craniotomy; avoids damage to surrounding brain

Treatment of primary infection site as required:

• to reduce the risk of recurrence
• surgical treatment - sinus or middle ear infection; cardiac surgery for infective valves
• physiotherapy and antibiotics - for pulmonary infection

Steroids may reduce oedema but reduce antibiotic penetration.

Prophylactic anticonvulsants - around 40-50% of patients with an intracranial abscess develops seizures. (2)

References:

• 1. Morgan R. Picture Quiz: Cerebral abscess. StudentBMJ 2003;11
• 2. Whitfield P. The Management of Intracranial Abscesses. ACNR 2005; 5(1)