cefotaxime and Brain-Abscess

The brain stem is an uncommon site of a brain abscess. Such lesions were invariably fatal before 1974, when the arrival of computed tomography and magnetic resonance imaging improved the prognosis. This new case with a good result shows the usefulness of early diagnosis, careful clinical and radiological monitoring and combined medical and surgical management. A child 2 1/2 years of age was admitted to the department of neurosurgery for diagnosis and treatment of a brain stem lesion. The clinical context and discovery of an intrabronchial foreign body, as well as neuroradiological investigations, suggested a diagnosis of brain stem abscess. Initial treatment with broad spectrum antibiotics with good cerebral penetration was associated with an increase in the size of the abscess and clinical worsening. Stereotactic aspiration of lesion was performed by a transpeduncular approach under CT guidance and general anaesthesia. Secondary thoracotomy enabled removal of an intrabronchial needle. After evacuation, in spite of failure to identify the organism, neurological deficit resolved rapidly and the lesion no longer appeared on CT. Management of a brain abscess always includes antibiotics. They must cover the organisms most often encountered in brain abscesses and have good cerebral penetration. Medical treatment seems to suffice for small abscesses. A brain stem abscess with rapid clinical signs, together with current neuroradiogical diagnostic techniques, enables early discovery of such abscesses when they are still small. Treatment of brain stem abscesses includes primary antibiotic therapy, then stereotaxic drainage when there is any diagnostic doubt, poor clinical tolerability or antibiotic resistance.

Topics: Amoxicillin; Brain Abscess; Brain Stem; Bronchi; Cefotaxime; Child, Preschool; Drainage; Drug Therapy, Combination; Female; Foreign Bodies; Humans; Metronidazole; Tomography, X-Ray Computed; Treatment Outcome

A case history and brief literature review of cerebral abscess related to dental therapy is presented. The 19-year-old male patient presented with a cerebral abscess caused by Actinobacillus actinomycetamcomitans. He was otherwise healthy, and had a recent history of periodontal surgery prior to the onset of symptoms. The patient was treated successfully with stereotactic aspiration and antibiotics.

Topics: Actinobacillus Infections; Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Brain Abscess; Cefotaxime; Cephalosporins; Chloramphenicol; Drug Therapy, Combination; Focal Infection, Dental; Humans; Male; Parietal Lobe; Periodontal Ligament; Postoperative Complications; Stereotaxic Techniques

The aim of the present investigation was to prospectively study the clinical and bacteriologic outcome of 15 consecutive patients with brain abscesses who were treated with surgical excision and cefotaxime (3 g every 8 hours) plus metronidazole (0.5 g every 8 hours) for at least 3 weeks. The patients were followed clinically and with computed tomographic (CT) examinations. All patients survived, and there were no recurrences within 1 year. CT scans showed an exponential decrease in the size of enhancement. Cultures of all six specimens obtained after < 24 hours of treatment with cefotaxime and metronidazole were positive compared with cultures of three of nine specimens obtained later (P = .017). Anaerobic bacteria were isolated from 2 of 3 patients given two doses of metronidazole or less compared with none of 12 given three doses or more (P = .029). Reversible side effects occurred in nine patients. It is concluded that cefotaxime plus metronidazole is an alternative treatment for brain abscess in addition to surgical excision because of their good abscess penetration, their ability to eradicate bacteria, and a good clinical outcome.

Topics: Adult; Brain Abscess; Cefotaxime; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Prospective Studies

Brain abscesses carries a high morbidity and mortality, and despite medical advances, it continues to pose diagnostic and therapeutic challenges worldwide. The traditional surgical approaches to treating brain abscess (burr hole aspiration and craniotomy) have both advantages and disadvantages and remain controversial. Here we report a single institution's experience with a new surgical approach for brain abscess.. We retrospectively analyzed 46 patients with intracranial abscess who underwent continuous irrigation and drainage through a double-cavity sleeve tube placed surgically in conjunction with a 4-week course of intravenous cefotaxime and metronidazole at Renmin Hospital of Wuhan University between January 2008 and December 2016. The patients' medical records were analyzed for demographic data, clinical presentation, predisposing factors, imaging findings, microbiological test results, treatments, surgical techniques, and outcomes.. The 46 patients included 29 males and 17 females, ranging in age from 22 to 74 years. A single abscess was detected in 34 patients, whereas 12 patients had multiple abscesses. The average duration of hospitalization was 12.6 days. After treatment, 38 of the 46 patients resumed a normal life despite minor deficits (Glasgow Outcome Score [GOS] 5), 6 patients exhibited slight neurologic deficits (GOS 4), and 2 patients died of severe systemic infection and multiorgan failure. In particular, a patient with a brain abscess broken into the ventricle recovered well (GOS 5). No patient required repeat aspiration or surgical excision.. Continuous brain abscess cavity irrigation and drainage with a double-cavity sleeve tube is an effective treatment for brain abscess and produces excellent results, especially for an abscess broken into the ventricle. It combines the advantages of burr hole aspiration and open craniotomy excision. It is easy to perform and reduces costs and damage to the patient, and also shortens hospitalization time and antibiotic treatment time, greatly reducing the likelihood of reoperation. This approach may be the optimal choice to treat brain abscess.

Topics: Adult; Aged; Anti-Bacterial Agents; Brain Abscess; Cefotaxime; Craniotomy; Drainage; Female; Glasgow Outcome Scale; Humans; Male; Metronidazole; Middle Aged; Retrospective Studies; Therapeutic Irrigation; Treatment Outcome; Trephining; Young Adult

Topics: Anti-Bacterial Agents; Brain Abscess; Cefotaxime; Cephalosporins; Cerebellar Ataxia; Diagnosis, Differential; Diverticulitis; Drug Therapy, Combination; Dysarthria; Humans; Linezolid; Liver Abscess; Lung Abscess; Magnetic Resonance Angiography; Male; Metronidazole; Middle Aged; Paraneoplastic Syndromes; Vasculitis

Topics: Anti-Bacterial Agents; Brain; Brain Abscess; Cefotaxime; Drug Therapy, Combination; Headache; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Vancomycin

Congenital dermal sinuses result from abnormal neurulation, and are uncommon. A spinal intramedullary abscess secondary to an infected dermoid cyst is very rare, and the functional prognosis is usually quite poor. We report on a 16-month-old child with tetraplegia secondary to intramedullary abscesses because of a dermoid cyst infection associated with a dermal sinus. The abscesses were drained, and the dermoid cyst was removed. Antibiotics were administered for 6 weeks after neurosurgery. The child was followed at a pediatric rehabilitation department. After 1 year, he was able to walk quickly and had regained appropriate upper limb motor function for his age. However, bladder sphincter dyssynergia persisted, requiring intermittent catheterization. This case highlights the importance of early diagnosis for surgical intervention and prolonged antibiotic therapy. Long-term follow-up by a multidisciplinary team allowed for the effective management of related neurologic, orthopedic, and bladder disorders.

Topics: Anti-Infective Agents; Bacteroidaceae Infections; Brain Abscess; Cefotaxime; Humans; Infant; Magnetic Resonance Imaging; Male; Metronidazole; Movement; Quadriplegia; Recovery of Function; Spina Bifida Occulta; Spinal Cord

Odontogenic infections are quite common and, in unusual cases, can extend beyond the oral cavity with potentially life-threatening complications.. A 35-year-old woman, G3P0020, underwent extraction of an infected left maxillary third molar tooth at 19 3/7 weeks of gestation and later presented with mental status changes. Computed tomography revealed left pterygoid muscle abscess, which progressed to brain abscess. She underwent multiple partial lobectomies to drain her recurrent brain abscess. The pregnancy continued until term, and she underwent a cesarean delivery.. Brain abscess is a rare but life-threatening complication of pregnancy. This case illustrates the potential complications after extraction of an infected tooth in pregnancy.

Topics: Adult; Anti-Bacterial Agents; Anticonvulsants; Brain Abscess; Cefotaxime; Cesarean Section; Dexamethasone; Drug Therapy, Combination; Female; Focal Infection, Dental; Humans; Infant, Newborn; Levetiracetam; Male; Meningoencephalitis; Metronidazole; Molar, Third; Piracetam; Pregnancy; Pregnancy Complications, Infectious; Radiography; Streptococcal Infections; Tooth Extraction; Treatment Outcome; Ultrasonography, Prenatal; Viridans Streptococci

We evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri. Twenty two patients with a S. milleri brain abscess were treated with metronidazole and cefotaxime, in accordance with recent recommendations by the British Society Of Antimicrobial Chemotherapy (BSAC). Seven patients who had Glasgow Coma Scales < or =11 also received rifampicin and high dose cefotaxime. The clinical response of the patients was determined.. A retrospective study at the Queen Elizabeth Hospital, Birmingham covering the period April 1996-March 2004 was carried out. Neurosurgical and anti-microbial therapeutic approaches were reviewed. Any evidence of improvement of clinical features and radiological disappearance of brain abscesses were determined.. Outcome was assessed using the Glasgow Outcome Score (GOS) at 3 and 6 months from the time of surgical intervention. Eighteen patients (82%) had a good outcome by 6 months, with an outcome score of 4-5. Thirteen patients resumed normal life despite minor deficits (GOS 5), while a further five patients had moderate disability though remained independent (GOS 4). One patient had a GOS of 3 and there were three deaths (14). The minimum time to radiological resolution of the abscess was within 1 month in six cases (27) These all represented solitary lesions that required a single drainage procedure in conjunction with 4 weeks of intravenous cefotaxime and metronidazole. Ten cases (45%) had resolution within 4 months and a further three cases took at least 6 months from the time of surgery to show radiological clearance.. This cohort of patients responded favourably to the guidelines recommended by the BSAC. This was confirmed by the Glasgow Outcome Score (GOS 4-5) at 6 months review. Cefotaxime at a higher dose with rifampicin was prescribed for patients presenting with a decreased conscious level (GCS 8-11), subsequent failure of anticipated clinical improvement or clinical deterioration. There was no clinically significant difference in GOS between the two treatment groups. An algorithm for management of brain abscess is presented, based on our clinical experience and review of the literature.

Topics: Adolescent; Adult; Aged; Algorithms; Anti-Infective Agents; Brain Abscess; Causality; Cefotaxime; Cohort Studies; Drainage; Female; Glasgow Outcome Scale; Humans; Male; Metronidazole; Middle Aged; Retrospective Studies; Rifampin; Risk Factors; Streptococcal Infections; Streptococcus milleri Group; Time Factors; Treatment Outcome

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Brain Abscess; Cefotaxime; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Meningitis; Tomography, X-Ray Computed

A 16-year-old adolescent presented with fever, lethargy and vomiting associated with mild dehydration. This was followed less than 24-hours later by loss of consciousness, seizures and clinical brain death. She had no prior medical illness, no hospital or frequent antibiotic exposure. There was no evidence of soft tissue or skin infection. Management included intravenous fluids, ampicillin and cefotaxime parenterally, dexamethasone, endotracheal intubation and mechanical ventilation. Her neurologic examination remained unchanged with areflexia, flaccid paralysis and fixed pupils. Post-mortem examination revealed an eight-centimetre right fronto-parietal lobe brain abscess. Cultures were positive for methicillin resistant Staphylococcus aureus. Although formerly a nosocomial pathogen affecting debilitated patients in the hospital setting, S aureus that is methicillin resistant is emerging as a community acquired pathogen affecting previously well patients.

Topics: Adolescent; Ampicillin; Brain Abscess; Cefotaxime; Community-Acquired Infections; Fatal Outcome; Female; Humans; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus

Sixty-six consecutive patients with brain abscesses referred to a department of neurosurgery during a 10-year period and treated with cefotaxime were studied retrospectively by means of a prospectively designed protocol whose main areas of emphasis were duration of antibiotic treatment, sterilization rate, clinical outcome in relation to prognostic factors, and side effects. Sixty-two of these patients were treated additionally with metronidazole, and surgery was performed in 53 patients. Mental status was altered in 33 patients, 11 of whom were comatose. Rupture of the abscess into the ventricles occurred in eight patients. Death was attributable to brain abscess formation in three patients (4.5%). Forty-six percent of the surviving patients recovered without any neurological deficits. Reversible adverse reactions, which occurred in 38 patients, were the most common reason for withdrawal of cefotaxime. In 76% of these cases, there was a significant improvement before the onset of the adverse reaction. The median duration of parenteral antibiotic treatment was 36, 41, 22, and 46 days in patients treated with excision, aspiration, evacuation of subdural empyema, and antibiotics alone, respectively. Taking prognostic factors into consideration, mortality attributable to brain abscess was lower than previously reported. This finding, along with the abscess sterilization results, indicates that cefotaxime in combination with metronidazole is a highly effective treatment but is associated with a high frequency of reversible side effects. The results indicate that a shorter duration of treatment should be investigated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Brain Abscess; Cefotaxime; Chi-Square Distribution; Child; Child, Preschool; Cohort Studies; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Metronidazole; Middle Aged; Neurosurgical Procedures; Prognosis; Prospective Studies; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Survival Rate; Treatment Outcome

Ventriculoperitoneal shunts were routinely used in the past in children with posterior fossa tumors and hydrocephalus. They can, however, cause a multitude of problems.. This report highlights a previously unencountered phenomenon of a pyogenic abscess forming within a posterior fossa ependymoma as a result of shunt infection. The shunt was exteriorized and the child treated with antibiotics before surgery was done. Only a partial excision of the tumor was possible, as the inflammatory response caused by the abscess had obliterated tissue planes.

Topics: Amikacin; Brain Abscess; Cefotaxime; Cerebellar Neoplasms; Child, Preschool; Combined Modality Therapy; Cranial Fossa, Posterior; Cranial Irradiation; Drug Therapy, Combination; Ependymoma; Gram-Negative Bacterial Infections; Humans; Hydrocephalus; Male; Neoplasm, Residual; Postoperative Complications; Prosthesis-Related Infections; Radiotherapy, Adjuvant; Skull Base Neoplasms; Ventriculoperitoneal Shunt

We are reporting 6 clinical cases corresponding to admitted patients with intracranial abscesses (4 in brain and 2 in cerebellum) due to chronic otogenic pathology. Five were men and one woman with ages between 25 and 74 years. We have analysed in each case the initial symptoms, otoscopic exam, the otic and cranial CT informed, diagnosis, treatment and evolution. In all of them, it was performed a drainage of the abscess by Neurosurgery and Radical mastoidectomy by our Service with positive result. Although it is an uncommon complication nowdays, the abscesses of otological cause must be always suspected in uncontrolled chronic otitis or poor response to medical treatment. Symptoms can be no characteristics and must be asked for a CT or IRM in case of doubt.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Female; Humans; Imipenem; Male; Metronidazole; Middle Aged; Otitis Media; Tomography, X-Ray Computed

Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.

Topics: Adult; Aged; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; beta-Alanine; Brain Abscess; Cefotaxime; Cilastatin; Cilastatin, Imipenem Drug Combination; Drainage; Drug Combinations; Drug Therapy, Combination; Female; Humans; Imipenem; Immunocompromised Host; Lupus Erythematosus, Systemic; Male; Middle Aged; Minocycline; Nocardia Infections; Postoperative Care; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia asteroides cerebral abscesses are rare but challenging intracranial lesions. Early diagnosis, institution of appropriate antimicrobial therapy, lack of underlying systemic disease and limited intracranial disease are recognized factors leading to good outcome. However, the optimal treatment approach has not been established and nocardial brain abscesses have been managed either conservatively, with steroetactic aspirations or with open craniotomy and enucleation. We present three cases of Nocardia asteroides cerebral abscesses cured only after neurosurgical enucleation, and discuss the current management alternatives and conclude that a more aggressive approach than that currently preferred for this entity may be more effective.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Brain Abscess; Brain Neoplasms; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Humans; Imipenem; Magnetic Resonance Imaging; Male; Nocardia asteroides; Nocardia Infections; Sulfadiazine; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Actinomyces; Adult; Anti-Bacterial Agents; Bacterial Infections; Brain Abscess; Capnocytophaga; Cefotaxime; Female; Heart Defects, Congenital; Humans; Metronidazole; Penicillin G; Penicillin V; Streptococcus

Topics: Anti-Inflammatory Agents; Brain Abscess; Cefotaxime; Cephalosporins; Female; Haemophilus Infections; Humans; Magnetic Resonance Spectroscopy; Methylprednisolone; Middle Aged; Streptococcal Infections

The history of a 4-week-old infant with meningitis and multiple cerebral abscesses caused by Salmonella enteritidis is reported. Management included successful treatment with a prolonged course of antibiotics, including ciprofloxacin, neurosurgical drainage and long-term immunoglobulin supplements. No adverse effects of joint toxicity were detected.

Topics: Amoxicillin; Ampicillin; Brain Abscess; Cefotaxime; Chloramphenicol; Ciprofloxacin; Drug Therapy, Combination; Female; Humans; Infant; Meningitis, Bacterial; Metronidazole; Salmonella enteritidis; Salmonella Infections

We report a case of a 42-year-old man man who presented with neurological symptoms and was found to have an intracranial abscess. A stereotactic aspiration of the abscess yielded a pure growth of Haemophilus paraphrophilus. The patient responded to treatment with cefotaxime. We postulate the mechanism of infection in this patient.

Topics: Adult; Brain; Brain Abscess; Cefotaxime; Cephalosporins; Ciprofloxacin; Haemophilus; Haemophilus Infections; Humans; Male; Stereotaxic Techniques; Tomography, X-Ray Computed

A previously healthy 43-y-old man, who had spent 2 weeks in northern India, was admitted to hospital after a 2-day history of pyrexia, confusion and frontal headache. Cranial computerized tomography (CT) showed an abscess in the right parietal lobe. Spinal fluid and blood cultures gave growth of Salmonella enteritidis within 24 h. Treatment with cefotaxime was initiated, but ceased after 3 weeks due to drug fever, and ciprofloxacin was then given orally for 4 months. After 6 months, the patient was considered cured. Cases of salmonella brain abscesses are reviewed.

Topics: Adult; Anti-Infective Agents; Brain Abscess; Cefotaxime; Cephalosporins; Ciprofloxacin; Enteritis; Humans; Immunocompetence; Male; Salmonella Infections

While there are concerns about the consequences of widespread use of quinolones, there are few reports of quinolone-resistant strains of Salmonella typhi or Salmonella paratyphi from the Indian subcontinent. We present a case report of a newborn with meningitis due to a quinolone-resistant strain of S. paratyphi B presenting to the Aga Khan University Hospital (AKUH).

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Brain Abscess; Cefotaxime; Cephalosporins; Ciprofloxacin; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Histocytochemistry; Humans; Imipenem; Infant, Newborn; Infant, Premature, Diseases; Meningitis, Bacterial; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi B; Thienamycins; Tomography, X-Ray Computed

In AIDS patients, non-typhoid salmonella metastatic abscesses in lung and brain due to bacteremia have been described previously. Here we present a case in which a group B Salmonella, serotype Copenhagen, caused right parietal subdural empyema. The etiologic diagnosis was based on culture of pus obtained from the lesion. The patient was treated for bacterial meningitis and made a good recovery. He is at present reasonably well and is taking ciprofloxacin as prophylaxis against salmonella relapse.

Topics: Adult; AIDS-Related Opportunistic Infections; Brain; Brain Abscess; Cefotaxime; Chloramphenicol; Ciprofloxacin; Empyema, Subdural; Humans; Male; Meningitis, Bacterial; Salmonella; Salmonella Infections; Serotyping; Tomography, X-Ray Computed

Topics: Adult; Antitrichomonal Agents; Brain Abscess; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Humans; Metronidazole

Cases of intracranial sepsis of otorhinogenic origin presenting to a regional neurosurgical centre from 1984 to 1992 were examined with regard to their microbiology and antibiotic sensitivities. The results lead us to believe that cefotaxime may have a role in the initial ENT management of the potentially complicated case of ear or sinus sepsis.

Topics: Bacteria; Brain Abscess; Cefotaxime; Chloramphenicol; Empyema, Subdural; Humans; Metronidazole; Microbial Sensitivity Tests; Otitis Media; Penicillins; Sinusitis

Micrococcus spp. are commensal organisms colonizing the body surfaces of humans. In a few instances these organisms have been reported to colonize ventricular shunts. We report a patient, with no overt evidence of immunosuppression, in whom Micrococcus luteus was responsible for intracranial suppuration at multiple sites.

Topics: Adult; Brain Abscess; Cefotaxime; Combined Modality Therapy; Craniotomy; Empyema, Subdural; Female; Humans; Micrococcus; Neurologic Examination; Tomography, X-Ray Computed

Topics: Aged; Antineoplastic Agents; Brain Abscess; Cefotaxime; Drug Therapy, Combination; Gentamicins; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Listeriosis; Male; Prednisone; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Vidarabine

Meningitis due to Staphylococcus aureus is uncommon, occurring primarily in patients with known preexisting abnormalities of the CNS (including patients who have undergone previous neurosurgery or trauma). We reviewed our experience with meningitis due to S. aureus in children seen at two medical centers. Among the 40 patients, 32 (80%) had a known predisposing abnormality of the CNS at the time of diagnosis of S. aureus meningitis; all of these 32 patients had had recent neurosurgery, most for placement or revision of a ventriculoperitoneal shunt. Eight patients had no known predisposing CNS abnormality. Four of these eight patients were known to be immunocompromised. The other four patients all had an occult CNS abnormality demonstrated during subsequent workup. Our series demonstrates that when the diagnosis of S. aureus meningitis is made in the absence of a known predisposing CNS abnormality or immunologic defect, then a timely search for an occult CNS abnormality should be undertaken.

Topics: Brain Abscess; Brain Neoplasms; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Dermoid Cyst; Drug Combinations; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Meningocele; Penicillins; Recurrence; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Tomography, X-Ray Computed

We present a patient with a Nocardia brain abscess who failed to respond to repeated neurosurgical aspiration in combination with sulfadiazine therapy but improved after additional treatment with cefotaxime.

Topics: Adult; Brain Abscess; Cefotaxime; Combined Modality Therapy; Drug Therapy, Combination; Humans; Male; Nocardia asteroides; Nocardia Infections; Radiography; Suction; Sulfadiazine

Fifty-nine patients were operated or punctured in 60 incidents of brain abscess from 1963-1989, twice as many in men as in women. The number of cases tripled in 1980 to an incidence of 3.6 per million inhabitants per year, supposedly due to the advent of computerized tomography. Simultaneously, the aetiology changed from staphylococci and Gram negative rods to dominance of streptococci and Haemophilus aphrophilus. Apart from temporal abscesses, there was no correlation between localisation in the brain and the bacterial species isolated. Ninety-five per cent of the specimens from untreated patients gave growth, but so did specimens from six of 18 patients treated with relevant antibiotics up to 11 days before puncture. Therefore, we recommend removal of pus by excision or puncture.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacteroides Infections; Brain Abscess; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Denmark; Escherichia coli Infections; Female; Gram-Positive Bacterial Infections; Haemophilus Infections; Humans; Infant; Infant, Newborn; Male; Methicillin; Metronidazole; Middle Aged; Penicillins; Retrospective Studies; Streptomycin; Sulfonamides

Since clinical trials comparing the efficacies of different antibiotic regimens for treatment of brain abscesses are difficult to perform, the choice of antibiotics must rely on the antibacterial spectrum and the ability of the drug to penetrate into the abscess fluid. The aim of this investigation was to study the ability of cefotaxime and its active metabolite desacetylcefotaxime to penetrate into brain abscesses. Eight patients were given 3 g of cefotaxime intravenously every 8 h. Abscess fluid samples, obtained at surgery at various times after dosing, and blood samples were analyzed for their concentrations of cefotaxime and desacetylcefotaxime by using a newly developed microbiological assay. The brain abscess concentrations of cefotaxime and desacetylcefotaxime were 1.9 +/- 1.7 and 4.0 +/- 2.2 mg/liter, respectively. Simultaneous concentrations in plasma were 2.0 +/- 1.0 and 3.9 +/- 1.8 mg/liter, respectively. With increasing time following cefotaxime dosing there was a significant increase in the abscess:plasma concentration ratio of desacetylcefotaxime. Since both cefotaxime and desacetylcefotaxime penetrate well into the brain abscess, reaching concentrations above the MIC for probable bacteria except gram-negative anaerobes, it is concluded that cefotaxime in combination with metronidazole may be used as an alternative in the treatment of brain abscesses.

Topics: Adult; Brain Abscess; Cefotaxime; Female; Humans; Injections, Intravenous; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Premedication; Streptococcus

Topics: Adolescent; Adult; Aged; Brain Abscess; Cefotaxime; Cephalosporins; Female; Humans; Male; Middle Aged

Topics: Adult; Brain Abscess; Cefotaxime; Cefoxitin; Dexamethasone; Humans; Male

A patient with a rapidly progressive brain stem syndrome is reported. CT scan showed a ring enhancing lesion in the pons and CSF examination showed elevated protein and pleocytosis. A pulmonary abscess containing Nocardia was found and antimicrobial therapy produced progressive reduction in size of the pontine lesion and clinical improvement without surgical drainage. This is the first documented diagnosis and survival of a medically treated patient with a brain stem abscess of presumed Nocardia etiology.

Topics: Brain Abscess; Cefotaxime; Drug Therapy, Combination; Humans; Male; Middle Aged; Nocardia Infections; Pons; Sulfamethoxazole; Tomography, X-Ray Computed; Trimethoprim

Topics: Adolescent; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis

Ceftriaxone is an investigational cephalosporin with a half-life of five to eight hours. In an uncontrolled study, we evaluated its efficacy and safety in 30 pediatric and 12 young adult patients with serious bacterial infections. This agent was administered to children at a dosage of 50 to 75 mg/kg/day intravenously in two divided doses. Those with CNS infections received 100 mg/kg/day. In adults, the dosage was 1 g either once or twice daily. The diseases we treated included pneumonia (17), sepsis (eight), ventriculoperitoneal shunt infections (three), osteomyelitis (three), brain abscess (two), peritonitis (two), and miscellaneous (seven). Clinical cures were achieved in all cases, although one child with cystic fibrosis and Pseudomonas pneumonia had persistent colonization in his sputum. No serious side effects were observed. Although not the agent of choice for many of these pathogens, ceftriaxone appears to represent an important alternative to therapy.

Topics: Bacteria; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Osteomyelitis; Pneumonia

Forty-three children (ten neonates, 15 infants and 18 older children) were treated with single daily doses of ceftriaxone (50 to 100 mg/kg) intravenously or intramuscularly for serious bacterial infections. The infections included meningitis (31 patients), brain abscesses (four patients), septicaemia (three patients), pleuro-pneumonia (two patients), septic arthritis and soft tissue phlegmona (three patients). No other antibacterial agents were used except in four patients with brain abscesses, in whom ceftriaxone was combined with ornidazole. The overall bacteriological cure rate was 98%, and sterilisation of the cerebrospinal fluid occurred in 27 of 28 patients (96%) with proven bacterial meningitis. Two patients died, three survived with severe neurological sequelae; one neonate required partial gut resection. A complete clinical cure was achieved in the remaining 37 patients. Only one treatment failure was directly related to the drug therapy. The only side effect noted were sterilisation of the gut with overgrowth of Candida albicans in 35% of neonates and infants, an prolonged fever in 13% of all patients. Ceftriaxone given in a 24-hourly regimen is convenient and highly effective in serious bacterial infections in children and is without significant toxicity.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Evaluation; Humans; Infant; Infant, Newborn; Meningitis; Pleuropneumonia; Sepsis