What is the treatment for meningitis with abscess?

From the Guidelines

Treatment of Meningitis with Abscess

Treatment of meningitis with abscess typically involves a combination of antimicrobial therapy and surgical intervention.

• Empiric antibiotic therapy with a third-generation cephalosporin, such as ceftriaxone (2g IV every 12 hours), and metronidazole (500mg IV every 8 hours) is recommended, with duration of treatment ranging from 4-6 weeks 1.
• In cases where Staphylococcus aureus is suspected or confirmed, vancomycin (1g IV every 12 hours) may be added to the regimen.
• Surgical drainage of the abscess is often necessary to achieve optimal outcomes, and may be performed in conjunction with antimicrobial therapy 1.
• The use of dexamethasone for treatment of severe symptoms because of perifocal oedema or impending herniation is recommended 1.
• Primary prophylaxis with antiepileptics is not recommended for patients with brain abscess 1.
• The recommended duration of antimicrobial treatment is 6-8 weeks 1.
• Early transition to oral antimicrobials and oral consolidation treatment after 6 weeks of intravenous antimicrobials are not routinely recommended 1.

From the FDA Drug Label

In the treatment of meningitis, it is recommended that the initial therapeutic dose be 100 mg/kg (not to exceed 4 grams). Thereafter, a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) is recommended. Central Nervous System (CNS) Infections, including meningitis and brain abscess, caused by Bacteroides species including the B. fragilis group.

The treatment for meningitis with abscess may involve ceftriaxone at a dose of 100 mg/kg/day (not to exceed 4 grams daily) and/or metronidazole for CNS infections, including meningitis and brain abscess, caused by susceptible anaerobic bacteria. Key points to consider:

• Dosage: ceftriaxone 100 mg/kg/day (not to exceed 4 grams daily)
• Causative organism: Bacteroides species, including B. fragilis group
• Antibiotic choice: ceftriaxone and/or metronidazole 2 3

From the Research

Treatment for Meningitis with Abscess

The treatment for meningitis with abscess typically involves a combination of antimicrobial therapy and surgical intervention.

• The choice of antimicrobial therapy should be based on the suspected bacterial pathogen and should include bactericidal antimicrobials that effectively cross the blood-brain barrier (BBB) to achieve cerebrospinal fluid (CSF) concentrations well above the minimum bactericidal concentration (MBC) for the suspected pathogen 4.
• The antimicrobial regimen should be tailored based on microbiological information, once available, and should consider the inclusion of antianaerobic therapy, even if bacterial cultures do not grow anaerobes 4.
• Surgical intervention, such as burr hole evacuation, may be necessary to drain the abscess, especially in cases where the abscess is large or causes significant mass effect 5.
• The duration of antimicrobial therapy for brain abscess is typically at least 6 weeks, with the specific duration depending on the clinical response and radiographic changes 4.

Antimicrobial Therapy

The choice of antimicrobial therapy for meningitis with abscess depends on the suspected bacterial pathogen.

• For pneumococcal meningitis, combination therapy including cefotaxim or ceftriaxone and vancomycin is recommended 6, 7.
• For other types of bacterial meningitis, such as Neisseria meningitidis or Haemophilus influenzae, a simple treatment with third-generation cephalosporin may be used 6.
• In cases where the minimal inhibitory concentration (MIC) of the pneumococcal strain is less than 0.5mg/L, third-generation cephalosporin should be continued alone for a total of 10 days 6.

Surgical Intervention

Surgical intervention is often necessary to drain the abscess and relieve pressure on the brain.

• Burr hole evacuation is a common procedure used to drain brain abscesses 5.
• The choice of surgical procedure depends on the location and size of the abscess, as well as the overall health of the patient 5.