Treatment of brain abscess with cefotaxime and metronidazole: prospective study on 15 consecutive patients

The aim of the present investigation was to prospectively study the clinical and bacteriologic outcome of 15 consecutive patients with brain abscesses who were treated with surgical excision and cefotaxime (3 g every 8 hours) plus metronidazole (0.5 g every 8 hours) for at least 3 weeks. The patients were followed clinically and with computed tomographic (CT) examinations. All patients survived, and there were no recurrences within 1 year. CT scans showed an exponential decrease in the size of enhancement. Cultures of all six specimens obtained after < 24 hours of treatment with cefotaxime and metronidazole were positive compared with cultures of three of nine specimens obtained later (P = .017). Anaerobic bacteria were isolated from 2 of 3 patients given two doses of metronidazole or less compared with none of 12 given three doses or more (P = .029). Reversible side effects occurred in nine patients. It is concluded that cefotaxime plus metronidazole is an alternative treatment for brain abscess in addition to surgical excision because of their good abscess penetration, their ability to eradicate bacteria, and a good clinical outcome.