Subdural empyema

- Typically secondary to otorhinologic infections or head trauma/cranial surgery.

- Diagnosis:  MRI

- Condition usually requires urgent surgical drainage.

 

Usual Pathogens
Polymicrobial:

Viridans Group Streptococci
Streptococcus anginosus group
Anaerobes:

  • Anaerobic Gram positive cocci
  • Bacteroides fragilis
  • Prevotella/Porphyromonas spp
  • Fusobacterium spp
Empiric Therapy Dose Duration
Ceftriaxone 2g IV q12h 6 weeks
+    
Metronidazole IV/PO 500mg IV/PO q8h  

Post-neurosurgical/osteomyelitis

Also:

S. aureus

Cutibacterium acnes

 

Empiric Therapy Dose Duration
Ceftriaxone 2g IV q12h 6 weeks
+    
Vancomycin 15mg/kg IV q8-12h  
+    

Metronidazole IV/PO

500mg IV/PO q8h