Antibiotics in Management of Intracranial Abscesses
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- Category: Vol. 84, December 2016
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Antibiotics in Management of Intracranial Abscesses, AYMAN T.M. MOHAMED, AHMED Z.M. ZOHDI, KHALED S.M. ANBAR, MOHAMED M.M. SALAMA and MOHAMED A.M. EL-BORADY
Abstract
Background: Brain abscess accounts for 8% of intracranial lesions in developing countries, where as in the west it accounts about 1-2%. The ideal way in management of intracranial abscesses remains a matter of controversy.
Objectives: Our aim in this study is to put an updated protocol of antibiotics for management of brain abscesses and to evaluate it regarding clinical and radiological outcome, recurrence rate, duration of antibiotic usage, and the duration of hospital stay.
Patients and Methods: This study was done over 30 patients presenting between November 2013 and June 2015 with intracranial abscesses managed either medically or surgically by aspiration through a bur hole, excision with open craniotomy, with a specific protocol of antibiotics and then followed up clinically and radiologically.
Results: There were twenty male (66.7%) and ten females (33.3%). A nearby cranial infection was the most common predisposing factor in fourteen patients (46.6%). The temporal lobe was the most common location of the abscess in our study in eleven patients (36.7%). The most common isolated organism was Methicillin-resistant Staphylococcus aureus (MRSA) in eight cases (26.7%). No growth was the result of the culture in twelve cases (40%). Four patients needed only medical management (13.3%). Six patients underwent complete excision as the primary management (20%). The remaining twenty patients underwent aspiration via a burr hole (66.6%). Twenty four patients (80%) had favorable outcome in form of complete clinical and radiological improvement. Five cases (16.6%) presented with recurrence, three were managed by surgical excision and two were managed medically with no mortalities.
Conclusion: The choice of antibiotic agents should be based on culture results when possible. In the absence of positive culture results, therapy with third-generation cepha-losporins combined with metronidazole and vancomycin can be considered.