Epidural and Subdural Infections Treatment & Management
- Author: J Stephen Huff, MD, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD more...
Supportive care, including intravenous access, fluid resuscitation, oxygen, and monitoring, as indicated
Emergency Department Care
Stabilization procedures may be needed. Most efforts are directed at examination and appropriate imaging for definitive diagnosis. Do not delay antibiotic therapy for imaging procedures or other workup in toxic patients or in those patients with a high likelihood of these disorders or when meningitis remains a possibility in the differential diagnosis. For nontoxic and stable patients, antibiotic therapy is ideally guided by results of abscess aspiration or drainage.
Spinal epidural abscess
Treatment is medical and surgical, with surgery frequently necessary if signs of spinal cord compression are present.
Empiric antibiotic coverage should include an antistaphylococcal penicillin or a cephalosporin.
Empirical antibiotic therapy in most cases should provide coverage against MRSA with vancomycin.
Immediate surgical evacuation of the empyema is necessary.
Some controversy exists as to whether a craniotomy flap or multiple burr holes are the superior therapy.
Direct antibiotic therapy against S aureus, the most common pathogen.
If a neurosurgical procedure has recently occurred, combination therapy, as described above, is recommended.
Seizure treatment or prophylaxis may be indicated, depending on the clinical situation.
Expeditious neurosurgical consultation should be initiated when either of these entities is suspected.
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