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Treatment of Brain abscess

Brain abscesses are a medical emergency because they can raise the pressure on the brain to a point that may be fatal. A stay in hospital will be required.

Medication is the first line of treatment if 

  • the abscess is relatively small, 
  • there are multiple abscesses,
  • it is deep within the brain, 
  • it is accompanied by meningitis, or 
  • surgery would be dangerous due to an underlying condition.

A very large dosage of antibiotic medication is injected directly into a vein. Unless a specific bacteria has been identified as the cause, broad spectrum antibiotics (effective against lots of types of bacteria) will be given, such as penicillin, or metronidazole. Alternatively, you may be treated with several different types of specific antibiotics, and if fungal infection is suspected then antifungal medications will also be given.

Surgery is an option if:

  • antibiotic and antifungal medications don’t work,
  • the pressure inside the brain is rising, or
  • the abscess may burst and spill fluid into the rest of the brain.

Surgery is mainly carried out to open up the abscess and drain it. At this stage, it is useful to take a sample of the fluid drained, to test it and make sure the right antibiotics or antifungals are being given.

If the abscess is near the surface it may be possible to remove the mass of infected pus and cells. If it is deep in the brain, it may be drained using a needle guided by a CT or MRI scan. Alternatively, antibiotics or antifungals may be injected directly into it.

If the infection has spread from elsewhere in the body, such as the ear or lungs, it is necessary to treat that site to prevent further infections in the brain.

In some cases, corticosteroid drugs such as dexamethasone are used to ease the swelling and reduce pressure inside the skull, but this is not fully proven to be beneficial, because steroid use can slow the rate at which antibiotic treatments work.