Antimicrobial prescribing: NHS Lothian
Blood cultures X 2 sets (10mls in each bottle)
Surgical drainage if possible is key.
Post surgical brain abscess/empyema
| Recommended antibiotic |
Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L PLUS Ceftazidime 2g IV 8 hourly PLUS Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)* |
|
Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L PLUS Ciprofloxacin 400mg IV 8 hourly** PLUS Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)* |
*Maximum duration of metronidazole should be 4 weeks unless indicated by infection specialist due to the risk of neuropathy
**Avoid fluoroquinolones if taking steroids and the elderly. Review MHRA Quinolone Warning before prescribing. If an alternative agent is required please contact microbiology.
Discuss with microbiology and neurosurgery
Conservative management or aspirated lesions: 6-8 weeks
Causative organisms in post-neurosurgical brain abscess include Staph aureus and Gram-negative organisms.