Contiguous 2° to otitis/mastoiditis/sinusitis/dental
(usually single abscess)
- Consult ENT.
- Surgical drainage often necessary if:
- lesions ≥ 2.5 cm, or at least one accessible abscess ≥ 1 cm
- gas present in abscess
- risk of herniation or rupture into ventricles
- no improvement with medical therapy.
Polymicrobial:
Viridans Group Streptococci including Streptococcus anginosus group (S. anginosus, S. constellatus, S. intermedius)
Anaerobes:
- Peptostreptococcus spp
- Bacteroides spp
- Prevotella spp
- Porphyromonas spp
- Fusobacterium spp
| Empiric Therapy | Duration | |
|---|---|---|
| Ceftriaxone | 2g IV q12h | 6-8 weeks |
| + | ||
| Metronidazole IV/PO | 500mg IV/PO q8h |
Ceftriaxone allergy, or if Temporal lobe
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Meropenem | 2g IV q8h |
Severe immunocompromise (i.e. haematological malignancies, organ transplant recipients)
Add voriconazole and TMP-SMX to above regimens.