Spinal Cord Infections Medication

Updated: Sep 26, 2018
  • Author: Andrew K Chang, MD, MS; Chief Editor: Liudvikas Jagminas, MD, FACEP  more...
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Medication

Medication Summary

The goal of therapy is to eradicate infections. The empiric antimicrobial therapy should take into account the mechanism of infection, which helps predict the most likely infection organism or organisms.

For example, for contiguous spread through a sinus tract opening, one suggested regimen is vancomycin plus cefotaxime plus metronidazole.

For postneurosurgical complication, a suggested regimen consists of vancomycin plus ceftazidime with or without metronidazole.

For cryptogenic infection (ie, no identified primary source), a suggested regimen is ampicillin plus cefotaxime plus metronidazole. Ampicillin must be administered to cover L monocytogenes.

For hematogenous spread, the choice of antibiotics obviously depends on the primary source of infection. The optimal duration of antimicrobial therapy is not well defined. One review recommended a minimum of 4-6 weeks of parenteral therapy, with consideration of an additional 2-3 months of oral antimicrobial therapy.

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Antibiotics

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Vancomycin (Vancocin, Vancoled, Lyphocin)

Potent antibiotic directed against gram-positive organisms and active against Enterococcus species. Useful in treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci.

Cefotaxime (Claforan)

Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth. Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms.

Metronidazole (Flagyl IV, Metro IV)

Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Used in combination with other antimicrobial agents (except for Clostridium difficile enterocolitis).

Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime)

Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.

Ampicillin (Marcillin, Omnipen, Principen, Polycillin-N)

Bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication orally.

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