Subdural Empyema Medication
- Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Niranjan N Singh, MD, DM more...
The goal of pharmacotherapy is to reduce morbidity and prevent complications.
Appropriate antibiotics always should be given in addition to any surgical intervention. While awaiting the results of the Gram stain and culture and sensitivities, empirical antibiotic therapy should be instituted against anaerobes, aerobic streptococci, and staphylococci. The antibiotics should be given for a period of 3-6 wk with close monitoring of clinical status.
Paranasal sinusitis - Beta-lactamase-stable penicillin + metronidazole + third-generation cephalosporin (except cefoperazone)
Otitis media, mastoiditis - Beta-lactamase-stable penicillin + metronidazole + third-generation cephalosporin (except cefoperazone)
Trauma, postsurgical infection - Vancomycin + third-generation cephalosporin (except cefoperazone)
Pulmonary spread - Beta-lactamase-stable penicillin + metronidazole + third-generation cephalosporin (except cefoperazone)
Meningitis in an infant or child - Vancomycin + third-generation cephalosporin (except cefoperazone)
Neonates - Ampicillin + third-generation cephalosporin (except cefoperazone)
Cefoperazone (Cefobid) is contraindicated because it may cause clotting impairment.
Third-generation cephalosporin with broad-spectrum activity including gram-negative organisms; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.
Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms. Arrests bacterial cell wall synthesis, which in turn inhibits bacterial growth.
Beta-lactamase-stable antistaphylococcal agent. Use parenteral therapy initially in severe infections. Change to oral therapy as condition warrants.
Because of risk of thrombophlebitis, particularly in elderly patients, administer parenterally only for short term (1-2 d); change to oral route as clinically indicated.
Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa.
Indicated for patients who cannot receive or have not responded to penicillins and cephalosporins or have infections with resistant staphylococci. Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing GI or genitourinary procedures.
To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use CrCl to adjust dose in patients diagnosed with renal impairment.
Third-generation penicillin with bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication orally.
Zimmerman RD, Leeds NE, Danziger A. Subdural empyema: CT findings. Radiology. 1984 Feb. 150(2):417-22. [Medline].
Chen CY, Huang CC, Chang YC. Subdural empyema in 10 infants: US characteristics and clinical correlates. Radiology. 1998 Jun. 207(3):609-17. [Medline].
Brennan MR. Subdural empyema. Am Fam Physician. 1995 Jan. 51(1):157-62. [Medline].
Greenlee JE. Subdural empyema. In: Mandell GL, ed. Principles and Practice of Infectious Diseases. Vol 1. 4th ed. New York: Churchill. 1994:900-903.
Feuerman T, Wackym PA, Gade GF. Craniotomy improves outcome in subdural empyema. Surg Neurol. 1989 Aug. 32(2):105-10. [Medline].
French H, Schaefer N, Keijzers G, Barison D, Olson S. Intracranial subdural empyema: a 10-year case series. Ochsner J. 2014 Summer. 14 (2):188-94. [Medline].
Sanford JP. Guide to antimicrobial therapy. Bethseda MD: Uniformed Services University Health Sciences. 1993. 3:
Delgado Tapia JA, Galera Lopez J, Santiago Martin J, et al. Subdural empyema due to Mycoplasma hominis after a cesarean section under spinal anesthesia. Rev Esp Anestesiol Reanim. 2005. 52(4):239-242. [Medline].
Dwarakanath S, Suri A, Mahapatra AK. Spontaneous subdural empyema in falciparum malaria: a case study. J Vector Borne Dis. 2004 Sep-Dec. 41(3-4):80-2. [Medline].
Foerster BR, Thurnher MM, Malani PN, Petrou M, Carets-Zumelzu F, Sundgren PC. Intracranial infections: clinical and imaging characteristics. Acta Radiologica. October 2007. 48(8):875-93. [Medline].
Hall WA, Truwit CL. The surgical management of infections involving the cerebrum. Neurosurgery. February 2008. 62 Supplement 2:519-30. [Medline].
Krauss WE, McCormick PC. Infections of the dural spaces. Neurosurg Clin N Am. 1992 Apr. 3(2):421-33. [Medline].
Mauser HW, Van Houwelingen HC, Tulleken CA. Factors affecting the outcome in subdural empyema. J Neurol Neurosurg Psychiatry. 1987 Sep. 50(9):1136-41. [Medline].
Migirov L, Eyal A, Kronenberg J. Intracranial complications following mastoidectomy. Pediatr Neurosurg. 2004 Sep-Oct. 40(5):226-9. [Medline].
Moorthy RK, Rajshekhar V. Intracranial Abscess. Neurosurg Focus. 2008. 24 (6):E3.