Multiple abscesses occur in 10-50% of patients. However, few data exist regarding optimal management. Management strategies have included empirical use of antibiotics alone; aspiration of a single lesion followed by antibiotics; open excision combined with aspiration and antibiotics; and multiple repeated aspirations, when necessary. The following recommendations and conclusions can be made regarding the management of multiple brain abscesses :
Emergency surgery, preferably by stereo-tactic aspiration is indicated for all abscesses greater than 2.5 cm in diameter or for any lesion producing significant mass effect.
If all lesions are less than 2.5 cm in diameter, then the largest abscess should be aspirated for culture material. Antibiotics should be withheld until samples are obtained for culture and/or biopsy.
Once cultures are obtained, broad-spectrum antibiotics should be initiated; adjustments should be made once culture and sensitivity results become available. Duration of intravenous antibiotic therapy should be a minimum of 6-8 weeks, and often for at least a year in immunocompro-mised patients.
CT or MRI should be obtained weekly during therapy, and then at monthly or bimonthly intervals, until the process has resolved radiographically.
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