Abstract
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.
Similar content being viewed by others
References
Mathiesen GE, Johnson JP (1997) Brain abscess. Clin Infect Dis 25:763–781
Louvois J de (1978) The bacteriology and chemotherapy of brain abscess. J Antimicrob Chemother 4:395–413
Wispelwey B, Scheld WM (1987) Brain abscess. Clin Neuropharmacol 10:483–510
Chun CH, Johnson JD, Hofstetter M, Raff MJ (1986) Brain abscess: a study of 45 consecutive cases. Medicine 65:415–431
Sjölin J, Eriksson N, Arneborn P, Cars O (1991) Penetration of cefotaxime and desacetylcefotaxime into brain abscesses in humans. Antimicrob Agents Chemother 35:2606–2610
Sjölin J, Lilja A, Eriksson N, Arneborn P, Cars O (1993) Treatment of brain abscess with cefotaxime and metronidazole: prospective study on 15 consecutive patients. Clin Infect Dis 17:857–863
Gomez J, Poza M, Martinez M, Martines J, Hernandez JL, Martin F, Canteras M, Valdes M (1991) Los abscesos cerebrales en un hospital general. Analisis de 66 casos consecutivos. Med Clin (Barc) 97:641–644
The “Infection in Neurosurgery” Working Party of the British Society for Antimicrobial Therapy (2000) The rational use of antibiotics in the treatment of brain abscess. Br J Neurosurg 14:525–530
Schliamser SE, Bäckman K, Norrby SR (1988) Intracranial abscesses in adults: an analysis of 54 consecutive cases. Scand J Infect Dis 20:1–9
Yang S, Zaho C (1993) Review of 140 patients with brain abscess. Surg Neurol 39:290–296
Johnson DL, Markle BM, Wiedermann BL, Hanahan L (1988) Treatment of intracranial abscesses with sinusitis in children and adolescents. J Pediatr 113:15–23
Seydoux Ch, Francioli P (1992) Bacterial brain abscesses: factors influencing mortality and sequelae. Clin Infect Dis 15:394–401
Black P, Graybill JR, Charache P (1973) Penetration of brain abscess by systemically administered antibiotics. J Neurosurg 38:705–709
Olaison L, Belin L, Hogevik H, Alestig K (1999) Incidence of beta-lactam-induced delayed hypersensitivity and neutropenia during treatment of infective endocarditis. Arch Intern Med 159:607–615
Skoutelis AT, Gogos CA, Maraziotis TE, Bassaris HP (2000) Management of brain abscesses with sequential intravenous/oral antibiotic therapy. Eur J Clin Microbiol Infect Dis 19:332–335
Brown EM, Strangelis G, Jamjoom A, Griffith HB (1994) Short-course antimicrobial therapy for brain abscess and subdural empyema. Proceedings of the 123rd Meeting of the Society of British Neurosurgical Surgeons. J Neurol Neurosurg Psychiatry 57:390–391
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jansson, AK., Enblad, P. & Sjölin, J. Efficacy and Safety of Cefotaxime in Combination with Metronidazole for Empirical Treatment of Brain Abscess in Clinical Practice: A Retrospective Study of 66 Consecutive Cases. Eur J Clin Microbiol Infect Dis 23, 7–14 (2004). https://doi.org/10.1007/s10096-003-1055-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-003-1055-7