How are spinal epidural abscesses treated?

Updated: Jul 12, 2018
  • Author: J Stephen Huff, MD, FACEP; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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  • Treatment most often consists of both medical [15] and surgical therapy.

  • Empiric antibiotic coverage should include antistaphylococcal antibiotics. With the increasing incidence of methicillin-resistant staphylococcal infections, coverage that includes antibiotics effective against MRSA is recommended. If the infection follows a neurosurgical procedure, an antistaphylococcal penicillin, a third-generation cephalosporin, and an aminoglycoside are prescribed in combination. Culture results guide definitive therapy.

  • If the patient remains neurologically stable and has a mechanically stable spine, some recommend that antibiotic treatment be delayed until material is obtained for a culture. [16]

  • Antibiotic treatment with CT-guided aspiration of the epidural space is increasingly used in patients without neurologic deficits.

  • Resolution of the abscess with antibiotics alone has been reported in patients who are not candidates for surgery because of spine instability or coexisting medical problems.

  • Deterioration of clinical and functional status while undergoing antibiotic therapy alone has been observed and may dictate emergency surgical decompression.

  • Because of the rarity of the disorder, no randomized trial results are available to guide the clinician.

  • For the rare case associated with the recent outbreak of fungal-contaminated methylprednisolone injections, the recommended drug is voriconazole at a dose of 6 mg/kg of body weight twice daily. [5]

  • No specific guidelines exist for children, but a recent case series showed benefit with medical therapy of most patients in that case series. [17]

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