From the Guidelines
Streptococcus intermedius brain abscesses in pediatric patients require prompt treatment with surgical drainage combined with prolonged antibiotic therapy, as recommended by the European Society of Clinical Microbiology and Infectious Diseases guidelines 1. The recommended treatment includes surgical aspiration or excision of the abscess followed by 4-6 weeks of intravenous antibiotics.
- The initial empiric antibiotic regimen typically consists of ceftriaxone (100 mg/kg/day divided q12h, maximum 4g/day) plus metronidazole (30 mg/kg/day divided q8h, maximum 4g/day) 1.
- Once S. intermedius is confirmed, therapy can be narrowed to high-dose penicillin G (300,000-400,000 units/kg/day divided q4-6h) or ceftriaxone 1.
- For penicillin-allergic patients, meropenem (120 mg/kg/day divided q8h, maximum 6g/day) is an alternative 1. Regular neuroimaging (MRI preferred) should be performed to monitor treatment response, typically at 2 weeks after initiation and before completing antibiotics 1. S. intermedius is part of the Streptococcus anginosus group and has a unique propensity to cause brain abscesses due to its production of hydrolytic enzymes that facilitate tissue destruction and abscess formation 1. These infections often result from contiguous spread from sinusitis, otitis media, or dental infections in children, and a thorough evaluation for these primary sources is essential for comprehensive management and prevention of recurrence 1.
From the Research
Strep Intermedius Brain Abscess in Pediatrics
- Strep intermedius is a rare cause of brain abscess in children, but it should be considered as a potential pathogen in the development of brain abscess in this population 2.
- A study reported four pediatric cases of brain abscess caused by S. intermedius, with favorable outcomes after antibiotic therapy and abscess puncture 2.
- Another study presented a case of a 2-year-old boy with a Streptococcus intermedius brain abscess and bilateral ventriculitis, which was successfully treated with high-dose penicillin G 3.
- A recent case report described a pediatric basal ganglia abscess due to Streptococcus intermedius, which was treated with neurosurgical drainage and led to full recovery 4.
Treatment and Management
- High-dose penicillin G therapy is one choice of treatment for brain abscess due to penicillin-susceptible streptococci, including S. intermedius 3.
- A study evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri, which includes S. intermedius, and found that it was effective in combination with metronidazole and rifampicin 5.
- Antibiotic therapy combined with needle aspiration or surgical drainage is a common approach to treating brain abscesses caused by S. intermedius 2, 6.
Clinical Presentation and Diagnosis
- Pediatric patients with S. intermedius brain abscess may present with febrile meningeal syndrome, seizures, and other neurological symptoms 2.
- Diagnosis is typically obtained by brain imaging combined with culture of cerebrospinal fluid 2.
- Prompt MRI with diffusion and attenuation analyses can allow for abscess identification and treatment 4.