Adjuvant Therapies for Brain Abscesses in Children

Medical Therapy

Corticosteroids

• Consider for elevated ICP: The use of steroids is generally considered to be indicated when there is considerable mass effect secondary to significant cerebral edema leading to neurological deficits and/or impending herniation. They should be reserved as a lifesaving measure for patients in whom significant mass effect and/or cerebral edema pose an imminent threat to survival or are significantly debilitating (87, 118).
• Minimize duration use: Corticosteroid use in the management of brain abscesses is controversial because steroids inhibit treatment of the abscess. The duration of their use should be minimized, and they should be tapered as rapidly as the clinical condition permits (60, 118).
• Steroids work counter to infection therapy: Steroids interfere with the body’s immune responses that play a role in limiting brain abscesses (130). Steroids may reduce penetration of antibiotics into abscess (128). Steroids may interfere with the formation of the capsule that effectively contains the infection and result in the formation of larger abscess cavities. For that reason, steroids should be avoided in patients with early and late cerebritis (55).

Antiepileptic drugs

• No guiding study for use of anticonvulsants: There are no studies to guide the prophylactic use of antiepileptic therapy in children with brain abscesses. Although some practitioners tend to favor short-term prophylactic use of these drugs in all children with a brain abscess involving cortical structures, others will start antiepileptic therapy only in patients whose presentation included a seizure (31).
• If used, continue for 3–6 months: Anticonvulsant therapy should be continued for approximately 3–6 months after the completion of treatment. At that time, an EEG should be performed, and this information should be used to determine whether or not to wean the patient from the anticonvulsant.
• Remember anticonvulsant interaction with antibiotics, if used: If anticonvulsants are started, pharmacological interactions between antibiotics and anticonvulsants must be considered in calculating dosages (31).