Neuro antibiotics

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Bell's Palsy

Steroids

Should be started within 72hrs of symptom onset[1]

Antivirals

Most likely no added benefit when combined with steroids.[4] However also little harm associated with antivirals especially in patients with normal renal function[3]

Brain abscess

Otogenic source

Sinogenic or odontogenic source

Penetrating trauma or neurosurgical procedures

Hematogenous source

No obvious source

Encephalitis

often it is unclear which type of encephalitis is present and starting Acyclovir empirically is appropriate

HSV encephalitis

HZV encephalitis

CMV encephalitis

  • Ganciclovir 5mg/kg IV every 12hr OR
  • Foscarnet 90mg/kg IV every 12 hrs

Epidural Abscess

Treat for 6-8 weeks

Meningitis

Neonates (up to 1 month of age)[6]

MRSA is uncommon in the neonate

> 1 month old[7]

Adult < 50 yr[8]

Adult > 50 yr and Immunocompromised[9]

Post Procedural (or penetrating trauma)[11]

Cryptococcosis Meningitis

Options

  • Amphotericin B 1mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
  • Amphotericin B 5mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily


Meningitis with severe PCN allergy

Meningitis with VP shunt

  • Coverage for skin contaminants (S. epidermis, S. aureus)
  • Vancomycin plus ceftriaxone plus shunt removal

Neisseria meningitidis Prophylaxis

  • Ceftriaxone 250mg IM once (if less than 15yr then 125mg IM)
  • Ciprofloxacin 500mg PO once
  • Rifampin 600 mg PO BID x 2 days
    • if < 1 month old then 5mg/kg PO BID x 2 days
    • if ≥ 1 month old then 10mg/kg (max at 600mg) PO BID x 2 days

Tetanus

Metronidazole:

  • 500 mg IV every 6 hours

(<1200g)

  • 7.5 mg/kg PO/IV q48h
  • First Dose: 7.5 mg/kg PO/IV x 1

(>1200g AND <1 Month Old)

  • <7 days old
    • 7.5-15 mg/kg/day PO/IV q12-24h
    • First Dose: 7.5-15 mg/kg PO/IV x 1
  • >7 days old
    • 15-30 mg/kg/day PO/IV q12h
    • First Dose: 7.5-15 mg/kg PO/IV x 1

(>1 Month Old)

  • 30 mg/kg/day PO/IV q6h
  • First Dose: 7.5 mg/kg PO/IV x 1
  • Max: 4 g/day

See Also

Antibiotics by diagnosis

For antibiotics by organism see Microbiology (Main)

References

  1. Vargish L. For Bell’s palsy, start steroids early; no need for an antiviral. J Fam Pract. Jan 2008; 57(1): 22–25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183838/pdf/JFP-57-22.pdf
  2. 2.0 2.1 UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
  3. 3.0 3.1 Gronseth GS, Paduga R. Evidence-based guideline update: Steroids and antivirals for Bell palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012Full Text
  4. Lockhart et al. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869.
  5. Rigamonti D. et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 1999; 52:189-96
  6. van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  7. van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  8. van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  9. van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  10. [Guideline] Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul. 15(7):649-59.
  11. van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702