Nonoperative treatment of brain abscesses in selected high-risk patients

Abstract

✓ In a series of eight high-risk patients, presumed intraparenchymal pyogenic brain abscesses resolved or decreased markedly in size with antibiotic therapy and without surgery. Cases were selected for antibiotic trial because of multiplicity or location of the abscesses and complicating medical conditions. Patients were alert or lethargic, with stable or improving early clinical courses. Diagnosis was made by computerized tomography (CT) brain scans and corroborative laboratory and diagnostic studies. Cases were closely monitored with serial CT scans. In six cases, bacteria were cultured from blood, cerebrospinal fluid, or fluid aspirated from one of multiple abscesses. Antibiotics were selected for specificity against the cultured organism, or consisted of high-dose penicillin plus chloramphenicol; therapy continued for a median of 7 weeks. Serial CT scans showed decreased abscess size by a mean of 2.4 weeks (range, 1 to 4 weeks) and resolution of contrast-enhancement and mass effects by a mean of 9.8 weeks (range, 8 to 14 weeks). Abscesses followed to resolution were significantly smaller (mean, 1.7 cm diameter, p < 0.01) than those not responding to similar courses of antibiotic therapy (mean, 4.2 cm diameter). Two patients died of causes unrelated to their abscesses; surviving patients have no neurological deficit (mean follow-up period, 25 months; range, 15 to 37 months). Guidelines are recommended for a treatment protocol to be cautiously applied for high-risk patients with small abscesses. Surgery is recommended in all other cases of pyogenic brain abscesses.

Role of CT Scan in Diagnosis and Management of Otogenic Intracranial Abscess

“…It is essential for selection, treatment and follow-up of patients [3]. Small abscesses can be treated with high doses of intravenous antibiotics and observing improvement by serial CT studies [4,5]. Large abscess should be drained.…”

Brain abscess in children

“…Although cerebritis, small solitary abscesses (Ͻ 2 cm in diameter), or those in which the causative agent has been identified can be treated with antimicrobials alone, 4,13,17,22 strong consideration should be given to surgical drainage followed by the prompt initiation of empirical broad-spectrum empiric antimicrobial therapy ( Table 1). The regimen can be refined once the offending organism or organisms and susceptibilities have been identified in the neurologically stable child in whom the abscess or abscesses are accessible.…”

Efficacy Observation of Continuous Irrigation and Drainage with Double Cavity Catheter in the Treatment of Brain Abscess: 16 Patients Report

“…When the brain abscess is highly suspected, a broad-spectrum antibiotic is applied at admission, so that a case in stage of encephalitis can be cured. The general principle of antimicrobial drug use: early, adequate, full course of treatment, combination if necessary, and application more than 7 weeks at least [8], can affect a radical cure, but the disadvantage is that it not knows what kind of bacterial infection, drugs can only use experience medicine, drug sensitivity is bad, side effect is big, cycle is long. According the traditional surgery treatment for brain abscess, the case fatality rate is higher, the damage to the patient's is bigger, especially to case of the functional areas and deep abscess.…”