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Epidural Abscess Medication

  • Author: Mark R Wallace, MD, FACP, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
Updated: Feb 17, 2016

Medication Summary

The duration of antibiotic therapy is not well defined, but 4-12 weeks is generally considered adequate. Concomitant osteomyelitis requires a 6- to 12-week course. A transition to highly bioavailable oral agents might be appropriate in some cases; rely on an infectious disease specialist consultant for guidance. (See Medical Treatment for empiric selections.) Monitoring the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) value may be helpful, as control of infection is usually associated with normalization of the nonspecific markers. Note that some patients are cured despite stubbornly elevated CRP/ESR values, but stopping therapy with high or rising values should always give one pause.



Class Summary

Empiric antimicrobial therapy must be comprehensive and cover all likely pathogens. Antibiotic combinations, usually vancomycin or another MRSA agent plus a broad gram-negative agent, are recommended in both intracranial epidural abscess and spinal epidural abscess while awaiting culture data. This approach ensures coverage for a broad range of organisms and polymicrobial infections. Once organisms and sensitivities are known, antibiotic monotherapy is recommended.

Ceftriaxone (Rocephin)


Third-generation cephalosporin with fair gram-negative and gram-positive activity. Superior CNS penetration. Arrests bacterial growth by binding to one or more penicillin-binding proteins. Does not cover MRSA, Pseudomonas species, or resistant nosocomial enterics.

Ceftazidime (Ceptaz, Fortaz)


Third-generation cephalosporin with broad-spectrum, gram-negative activity (including Pseudomonas species). Poor efficacy against gram-positive organisms and some resistant gram-negative organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

Meropenem (Merrem IV)


Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Effective against most gram-positive and gram-negative bacteria, with excellent CNS penetration. Has slightly increased activity against gram-negative bacteria and slightly decreased activity against staphylococci and streptococci compared with imipenem, but much less likely than imipenem to cause seizures.

Metronidazole (Flagyl, Protostat)


Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Not active against any aerobes. Must be used in combination for most bacterial infections.

Vancomycin (Lyphocin, Vancocin)


Potent antibiotic directed against most gram-positive organisms and active against most Enterococcus species. Indicated in patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections with MRSA or another susceptible gram-positive organism.

Nafcillin (Nafcil, Unipen)


A penicillin used almost exclusively for MSSA. Is not effective against MRSA infections. Do not use empirically when MRSA infection is possible.

Contributor Information and Disclosures

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.


Gopala K Yadavalli, MD Residency Educator, Department of Internal Medicine, Boston Medical Center

Gopala K Yadavalli, MD is a member of the following medical societies: American Association for the Advancement of Science, American Society for Microbiology, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Aadia Rana, MD Assistant Professor of Medicine, Warren Alpert Medical School of Brown University

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Fred A Lopez, MD Associate Professor and Vice Chair, Department of Medicine, Assistant Dean for Student Affairs, Louisiana State University School of Medicine

Fred A Lopez, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, Infectious Diseases Society of America, Louisiana State Medical Society

Disclosure: Nothing to disclose.

  1. Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. 2008 Jan. 101(1):1-12. [Medline].

  2. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006 Nov 9. 355(19):2012-20. [Medline].

  3. Tsiodras S, Falagas ME. Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res. 2006 Mar. 444:38-50. [Medline].

  4. Grewal S, Hocking G, Wildsmith JA. Epidural abscesses. Br J Anaesth. 2006 Mar. 96(3):292-302. [Medline].

  5. Kabbara A, Rosenberg SK, Untal C. Methicillin-resistant Staphylococcus aureus epidural abscess after transforaminal epidural steroid injection. Pain Physician. 2004 Apr. 7(2):269-72. [Medline].

  6. Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. 2004 May. 79(5):682-6. [Medline].

  7. Tang HJ, Lin HJ, Liu YC, Li CM. Spinal epidural abscess--experience with 46 patients and evaluation of prognostic factors. J Infect. 2002 Aug. 45(2):76-81. [Medline].

  8. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000 Dec. 23(4):175-204; discussion 205. [Medline].

  9. Tunkell, AR. Subdural empyema, epidural abscess, and suppurative intracranial thrombophlebitis. Mandell GL, Bennet JE, Dolin R. Mandell, Douglas, and Bennett's Principles and Practices of Infectious Diseases. 2005. 1165-8.

  10. Hlavin ML, Kaminski HJ, Fenstermaker RA, White RJ. Intracranial suppuration: a modern decade of postoperative subdural empyema and epidural abscess. Neurosurgery. 1994 Jun. 34(6):974-80; discussion 980-1. [Medline].

  11. Gerberding JL, Romero JM, Ferraro MJ. Case records of the Massachusetts General Hospital. Case 34-2008. A 58-year-old woman with neck pain and fever. N Engl J Med. 2008 Oct 30. 359(18):1942-9. [Medline].

  12. Chiller TM, Roy M, Nguyen D, Guh A, Malani AN, Latham R. Clinical findings for fungal infections caused by methylprednisolone injections. N Engl J Med. 2013 Oct 24. 369(17):1610-9. [Medline].

  13. Chen WC, Wang JL, Wang JT, Chen YC, Chang SC. Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes. J Microbiol Immunol Infect. 2008 Jun. 41(3):215-21. [Medline].

  14. Lury K, Smith JK, Castillo M. Imaging of spinal infections. Semin Roentgenol. 2006 Oct. 41(4):363-79. [Medline].

  15. An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res. 2006 Mar. 444:27-33. [Medline].

  16. Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr. Medical vs surgical management of spinal epidural abscess. Arch Intern Med. 2004 Dec 13-27. 164(22):2409-12. [Medline].

  17. Sorensen P. Spinal epidural abscesses: conservative treatment for selected subgroups of patients. Br J Neurosurg. 2003 Dec. 17(6):513-8. [Medline].

  18. Avilucea FR, Patel AA. Epidural infection: Is it really an abscess?. Surg Neurol Int. 2012. 3(Suppl 5):S370-6. [Medline].

  19. Curry WT Jr, Hoh BL, Amin-Hanjani S, Eskandar EN. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol. 2005 Apr. 63(4):364-71; discussion 371. [Medline].

  20. Pereira CE, Lynch JC. Spinal epidural abscess: an analysis of 24 cases. Surg Neurol. 2005. 63 Suppl 1:S26-9. [Medline].

  21. Savage K, Holtom PD, Zalavras CG. Spinal epidural abscess: early clinical outcome in patients treated medically. Clin Orthop Relat Res. 2005 Oct. 439:56-60. [Medline].

  22. Karikari IO, Powers CJ, Reynolds RM, Mehta AI, Isaacs RE. Management of a spontaneous spinal epidural abscess: a single-center 10-year experience. Neurosurgery. 2009 Nov. 65(5):919-23; discussion 923-4. [Medline].

  23. Kim SD, Melikian R, Ju KL, Zurakowski D, Wood KB, Bono CM. Independent predictors of failure of nonoperative management of spinal epidural abscesses. Spine J. 2013 Oct 30. [Medline].

  24. Patel AR, Alton TB, Bransford RJ, Lee MJ, Bellabarba CB, Chapman JR. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J. 2014 Feb 1. 14(2):326-30. [Medline].

  25. Velazquez A, DeRyke CA, Goering R, Hoover V, Wallace MR. Daptomycin non-susceptible Staphylococcus aureus at a US medical centre. Clin Microbiol Infect. 2013 Dec. 19(12):1169-72. [Medline].

  26. Bucheit J, Collins R, Joshi P. Methicillin-resistant Staphylococcus aureus epidural abscess treated with ceftaroline fosamil salvage therapy. Am J Health Syst Pharm. 2014 Jan 15. 71(2):110-3. [Medline].

  27. Lohr M, Reithmeier T, Ernestus RI, Ebel H, Klug N. Spinal epidural abscess: prognostic factors and comparison of different surgical treatment strategies. Acta Neurochir (Wien). 2005 Feb. 147(2):159-66; discussion 166. [Medline].

  28. Kowalski TJ, Layton KF, Berbari EF, et al. Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol. 2007 Apr. 28(4):693-9. [Medline].

  29. Davis DP, Wold RM, Patel RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2004 Apr. 26(3):285-91. [Medline].

CT scan showing a lenticular-shaped intracranial epidural abscess.
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