Clinical and Microbiologic Features Guiding Treatment Recommendations for Brain Abscesses in Children

Abstract

We recommend ceftriaxone/cefotaxime and metronidazole as empiric treatment, although metronidazole may be unnecessary in many cases, with antistaphylococcal cover in cases of head trauma. Meropenem potentially would be a better choice in the immunocompromised. A prospective study of intravenous and oral treatment guided by clinical improvement is required beause 1-2 weeks of intravenous antibiotics during a total of 6 weeks may be sufficient in children.

Management and outcomes in children with sinogenic intracranial abscesses

“…In previous studies [5,19], MRI has been shown to be superior to contrast-enhanced CT for identifying intracranial abscesses. In the current study, a high sensitivity was demonstrated with contrastenhanced CT, which is also the preferred modality for evaluating sinus disease [20] and has been advocated in the setting of intracranial complications of sinusitis [20,21].…”

“…The S. milleri group consists of three similar viridans Streptococci species (S. anginosus, S. intermedius and S. constellatus), which are part of the normal oro-and nasopharyngeal flora. S. milleri has previously been cited as a common cause of sinogenic abscess [28,29], and a recent multi-centre study of intracranial abscesses of all causes in children over a 10-year period cited S. milleri as the most common causative organism [19].…”

“…Felsenstein et al [19] have recently recommended that for the treatment of intracranial abscesses of various causes in children, a third-generation cephalosporin and metronidazole should be used as first-line treatment. In the current series, deviation from this antimicrobial treatment strategy only occurred in patients with drug allergies, concomitant infections, or cultures of Staphylococcus aureus, when vancomycin was preferred.…”

The uselessness of procalcitonin in the diagnosis of focal bacterial central nervous system infection

“…On the other hand, incidences of subdural empyema which develops due to the progression of sinusitis or otitis media, brain abscess which is likely to develop in the patients with congenital heart disease and device infection such as VP shunt have not decreased even after the introduction of these conjugate vaccines [7,8]. In fact, most of the causative pathogens of the patients diagnosed as having focal CNS infection were bacteria which could not be prevented by these conjugate vaccines.…”

Brain Abscess due to Streptococcus Intermedius Secondary to Tetralogy of Fallot in a Child: A Case Report

“…[13] Previous studies have also shown that this group of bacteria can cause development of brain abscess. [14][15][16] Access to central nervous system through oral, dental, or gastrointestinal tract as result of bacteremia has been suggested. As seen in our patient, cardiac etiologies can be eliminated with echocardiographic examination.…”