Intracranial Abscess

Patient Population:
Pediatric
Condition Major Pathogens  First-choice Therapy Alternative Therapy Comments

Intracranial abscess or empyema (epidural, subdural, brain) > 3 months old, community-onset 

Includes intracranial extension of sinus, orbital or ear infections  

Streptococci (aerobic & anaerobic) 

Anaerobic oral and sinus flora 

Other organisms depending on source 

Ceftriaxone  
50 mg/kg/dose (max 2000 mg/dose) IV q12h  

AND 

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

AND  

Vancomycin  
(follow link for dosing & monitoring)   

Penicillin or cephalosporin allergy with higher risk for allergic reaction: 

Vancomycin  
(follow link for dosing & monitoring)  

AND 

Aztreonam  
30 mg/kg/dose (max 2000 mg/dose) IV q6h  

AND  

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

Neurosurgery and ID consults recommended 

Treatment is modified based on cultures, with vancomycin discontinued if MRSA is not identified 

Duration: Variable, guided by extent of drainage and response to therapy in follow-up assessments, usual range 4-8 weeks 
CNS infection in immunocompromised patient, or hospital-acquired, or following neurosurgical intervention, or following trauma  Variable based on risk factors  Consult ID for recommendations    Neurosurgery and ID consults recommended 
Central Nervous System Infections