Subdural Empyema Medication

Updated: Oct 28, 2022
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Medication Summary

The goal of pharmacotherapy is to reduce morbidity and prevent complications.

Intravenous antibiotics for a total period of 3–6 weeks can be administered on either an inpatient or outpatient basis.

Antiepileptic medication may be indicated.



Class Summary

Appropriate antibiotics always should be given in addition to any surgical intervention. While awaiting the results of the Gram stain and culture and sensitivities, empirical antibiotic therapy should be instituted against anaerobes, aerobic streptococci, and staphylococci. The antibiotics should be given for a period of 3-6 wk with close monitoring of clinical status.

Paranasal sinusitis - Beta-lactamase-stable penicillin + metronidazole + third-generation cephalosporin (except cefoperazone)

Otitis media, mastoiditis - Beta-lactamase-stable penicillin + metronidazole + third-generation cephalosporin (except cefoperazone)

Trauma, postsurgical infection - Vancomycin + third-generation cephalosporin (except cefoperazone)

Pulmonary spread - Beta-lactamase-stable penicillin + metronidazole + third-generation cephalosporin (except cefoperazone)

Meningitis in an infant or child - Vancomycin + third-generation cephalosporin (except cefoperazone)

Neonates - Ampicillin + third-generation cephalosporin (except cefoperazone)

Cefoperazone (Cefobid) is contraindicated because it may cause clotting impairment.

Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum activity including gram-negative organisms; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Cefotaxime (Claforan)

Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms. Arrests bacterial cell wall synthesis, which in turn inhibits bacterial growth.

Nafcillin (Nafcil, Unipen, Nallpen)

Beta-lactamase-stable antistaphylococcal agent. Use parenteral therapy initially in severe infections. Change to oral therapy as condition warrants.

Because of risk of thrombophlebitis, particularly in elderly patients, administer parenterally only for short term (1-2 d); change to oral route as clinically indicated.

Metronidazole (Flagyl)

Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa.

Vancomycin (Vancocin)

Indicated for patients who cannot receive or have not responded to penicillins and cephalosporins or have infections with resistant staphylococci. Used in conjunction with gentamicin for prophylaxis in penicillin-allergic patients undergoing GI or genitourinary procedures.

To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use CrCl to adjust dose in patients diagnosed with renal impairment.

Ampicillin (Principen)

Third-generation penicillin with bactericidal activity against susceptible organisms. Alternative to amoxicillin when unable to take medication orally.