Partial Oral Antibiotic Treatment for Bacterial Brain Abscess
Denmark400 participantsStarted 2020-11-06
Plain-language summary
The investigators aim to determine if oral antibiotics are clinically acceptable as treatment of brain abscess. Following 2 weeks of standard intravenous antibiotic therapy, half of patients will continue with this treatment for another 4 weeks or longer while the other half will be assigned to oral antibiotics for the remaining duration of treatment.
Who can participate
Age range18 Years
SexALL
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Inclusion criteria
✓. A clinical presentation (e.g. headache, neurological deficit or fever) and cranial imaging (CT or MRI) consistent with brain abscess AND
✓. The physician responsible for the patient decides to treat the patient for bacterial brain abscess AND
✓. Ability to take and absorb oral medications (including by nasogastric tube) AND
✓. To have received relevant antibiotic therapy for bacterial brain abscess for 14 consecutive days before randomisation AND
✓. Expected to be treated with antibiotic therapy for at least another 14 days after time of randomisation AND
✓. No progression in symptom intensity or occurrence of new-onset neurological symptoms (excluding seizures) within five days before time of randomisation.
Exclusion criteria
✕. Expected substantially reduced compliance with treatment (e.g. IV drug abuse)
✕. Pregnancy (proven by positive urine or plasma human chorionic gonadotropin test in fertile women \<50 years of age)
✕. Concomitant (empirical) brain abscess treatment for tuberculosis, nocardiosis, Pseudomonas spp., fungi, toxoplasmosis or other CNS parasites
✕. Device related brain abscesses (e.g. deep brain stimulators, ventriculo-peritoneal shunts)
✕. Severe immuno-compromise defined as ongoing need for biological- or chemotherapy, prednisolone \>20 mg/day for 14 days or longer, uncontrolled HIV/AIDS, haematological malignancies, and organ transplant recipients