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Antibiotic treatment of abscesses of the central nervous system
Abstract:
Samples of intracranial pus and serum from 32 patients were assayed to determine the concentrations reached in them of penicillin, ampicillin, cloxacillin, cephaloridine, gentamicin, chloramphenicol, fusidic acid, and lincomycin. Metronidazole had not been given. Penicillin penetrated abscesses reasonably well, but other beta-lactam antibiotics did not. The penetration of chloramphenicol was erratic. Aminoglycosides penetrated poorly, but lincomycin and fusidic acid penetrated well. Assay of sulphonamides and co-trimoxazole in pus was unreliable. These studies indicate that treatment of abscesses of the central nervous system should be considered according to the site and the likely antecedent cause. Abscesses of sinusitic origin, usually in the frontal lobe, yield penicillin-sensitive streptococci. Penicillin is the drug of choice. Abscesses of otitic origin, usually in the temporal lobe, yield a mixed flora, often including anaerobic bacteria. Multiple antibiotic therapy is indicated. Abscesses of metastatic or cryptogenic origin yield streptococci or mixed cultures, and multiple therapy is appropriate while awaiting the bacteriological results. Spinal and post-traumatic abscesses yield Staphylococcus aureus, and fusidic acid is the drug of choice.
Insights
Penicillin effectively penetrates brain abscesses, while other beta-lactam antibiotics show poor penetration. Antibiotic choice for central nervous system abscesses depends on the infection
Area of Science:
- Pharmacology
- Infectious Diseases
- Neurosurgery
Background:
- Central nervous system (CNS) abscesses require effective antibiotic penetration for successful treatment.
- Understanding antibiotic concentrations in intracranial pus and serum is crucial for optimizing therapy.
Purpose of the Study:
- To determine the penetration of various antibiotics into intracranial abscesses.
- To guide antibiotic selection for CNS abscesses based on causative pathogens and abscess location.
Main Methods:
- Assay of penicillin, ampicillin, cloxacillin, cephaloridine, gentamicin, chloramphenicol, fusidic acid, and lincomycin concentrations in intracranial pus and serum from 32 patients.
- Correlation of antibiotic penetration with abscess origin and likely bacterial flora.
Main Results:
- Penicillin demonstrated good penetration into abscesses; other beta-lactams showed poor penetration.
- Chloramphenicol penetration was erratic; aminoglycosides penetrated poorly.
- Lincomycin and fusidic acid exhibited good penetration.
- Assays for sulfonamides and co-trimoxazole in pus were unreliable.
Conclusions:
- Antibiotic selection for CNS abscesses should be guided by abscess site and suspected etiology.
- Sinusitic or otitic abscesses may require penicillin or combination therapy, respectively.
- Staphylococcus aureus abscesses (spinal, post-traumatic) are best treated with fusidic acid.