Anti-infective treatment of brain abscess

Expert Rev Anti Infect Ther. 2018 Jul;16(7):565-578. doi: 10.1080/14787210.2018.1489722. Epub 2018 Jul 5.

Abstract

Introduction: Brain abscess is an uncommon and potentially life-threatening infection of the CNS that can be caused by a range of different pathogens including bacteria, fungi, and parasites. A multidisciplinary approach is important and anti-infective treatment remains crucial. Here, we review anti-infective treatment of brain abscess. Areas covered: We used the terms '(Brain abscess[ti] AND (antibiotic* OR treatment)) NOT case report'), to conduct a search in the PubMed. Additional papers were identified by cross-reference checking and by browsing textbooks of infectious diseases and neurology.

Commentary: Empiric treatment of bacterial brain abscess consists of cefotaxime and metronidazole with the addition of vancomycin if meticilline-resistant Staphylococcus aureus is suspected. For severely immuno-suppressed patients, for example transplant recipients, voriconazole and trimethoprim-sulfamethoxazole or sulfadiazine should be added. Increased knowledge of the pharmacokinetic profile of anti-infective treatments may help to improve the treatment of brain abscess. Future studies should address efficacy and safety of continuous abscess drainage, mode of anti-infective administration (continuous vs. bolus), and anti-infective treatments in immuno-suppressed patients.

Keywords: Brain abscess; anti-infective; antibiotic; antifungal; antimicrobial; review; therapy; treatment.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Anti-Infective Agents / pharmacokinetics
  • Anti-Infective Agents / therapeutic use*
  • Brain Abscess / drug therapy*
  • Brain Abscess / microbiology
  • Central Nervous System Bacterial Infections / drug therapy
  • Central Nervous System Bacterial Infections / microbiology
  • Central Nervous System Fungal Infections / drug therapy
  • Central Nervous System Fungal Infections / microbiology
  • Central Nervous System Parasitic Infections / drug therapy
  • Central Nervous System Parasitic Infections / microbiology
  • Drainage / methods
  • Humans
  • Immunocompromised Host*

Substances

  • Anti-Infective Agents