Pediatric Guidelines: CNS Infections - Brain Abscess

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments

Brain abscess > 3 months old, community-onset

Or intracranial extension of sinus, orbital or ear infections

Streptococci (aerobic & anaerobic)

Anaerobic oral and sinus flora

Other organisms depending on source

Ceftriaxone 50mg/kg/dose IV q12h (max 2g/dose)

AND

Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose)

AND 

Vancomycin 20mg/kg/dose IV q6-8h (initial max 1g/dose)

Severe beta lactam allergy:

Vancomycin 20mg/kg/dose IV q6-8h (initial max 1g/dose)

AND

Aztreonam 30mg/kg/dose IV q6h (max 2g/dose)

AND 

Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose)

ID consult recommended

CNS infection, hospital-acquired or following neurosurgical intervention, or following trauma

Variable based on risk factors

Consult ID for recommendations

  ID consult recommended

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).