Epidural Abscess Medication

  • Author: Mark R Wallace, MD, FACP, FIDSA; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 13, 2011
 

Medication Summary

The course of medication 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.

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Antibiotics

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.

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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.

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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.

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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.

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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.

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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.

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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.

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Contributor Information and Disclosures
Author

Mark R Wallace, MD, FACP, FIDSA  Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease Fellowship Program, Orlando Regional Medical Center

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

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

Disclosure: Nothing to disclose.

Gopala K Yadavalli, MD  Staff Physician and Chief, Infectious Diseases Clinic, Louis Stokes Cleveland Veterans Affairs Medical Center; Associate Program Director, Internal Medicine, University Hospitals Case Medical Center; Assistant Professor of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and Louisiana State Medical Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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