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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Classically the treatment is by drainage, culture and antibiotic administration.


  • should be used in
    • multiple abscesses
    • abscesses located deep inside the brain (1)
  • consult bacteriologist re: appropriate antibiotics. Blind therapy may involve ceftazidime (cover gram +ve's and gram -ve's), metronidazole (cover anaerobes) and flucloxacillin (cover staphylococcus aureus)
  • switch to more specific treatments once organisms identified

Abscess drainage:

  • primary excision of whole abscess - standard for cerebellar abscess; risk of damage to surrounding brain tissue
  • burr hole aspiration - simple, safe, may need repeating
  • open evacuation - involves craniotomy; avoids damage to surrounding brain

Treatment of primary infection site as required:

  • to reduce the risk of recurrence
  • surgical treatment - sinus or middle ear infection; cardiac surgery for infective valves
  • physiotherapy and antibiotics - for pulmonary infection

Steroids may reduce oedema but reduce antibiotic penetration.

Prophylactic anticonvulsants - around 40-50% of patients with an intracranial abscess develops seizures. (2)


  • 1. Morgan R. Picture Quiz: Cerebral abscess. StudentBMJ 2003;11
  • 2. Whitfield P. The Management of Intracranial Abscesses. ACNR 2005; 5(1)

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