Management of bacterial brain abscesses

Abstract

Brain abscesses are well-known lesions that have been reported from the beginning of the Hippocratic era. They continue, however, to be characterized by problematic and fatal features, even though there have been enormous developments in treatment and diagnostic technologies-especially in the areas of computed tomography (CT), surgery, anesthesia, bacterial isolation techniques, and new antibiotics. The predisposing factors may change according to patient age, geographic location, and socioeconomic conditions of the community, but patients frequently have a contiguous infection such as otitis or mastoiditis. The clinical signs and symptoms of brain abscesses are nonspecific. Patients typically present with signs and symptoms due to mass effects, accompanied by high fever and seizure. The main treatment is surgical, although medical therapy can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or free hand, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. The success of the treatment, whether surgical or medical, mostly depends on the success of isolation of the causative organism, which provides essential data for accurate medical treatment. Third-generation cephalosporins and metronidazole are the most commonly used antimicrobial agents in the treatment of brain abscesses. Use of corticosteroids may be acceptable when lesions are accompanied by edema. Prophylactic antiepileptic therapy is strongly recommended. The patient's Glasgow Coma Scale score at presentation is one of the most important factors predicting outcome.