Adults with spinal epidural abscess who have had a recent spinal procedure or have implanted spinal prosthetic material

For adults with spinal epidural abscess who have had a recent spinal procedure or have implanted spinal prosthetic material, while awaiting susceptibility results, use:

vancomycin intravenously; for initial dosing, see Intermittent vancomycin dosing for noncritically ill adults. See advice on modification and duration of therapy vancomycin vancomycin vancomycin

PLUS

cefepime 2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefepime dosage adjustment. See advice on modification and duration of therapy. cefepime cefepime cefepime

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use cefepime plus vancomycin (see dosages above).

For patients who have had a severe immediate¹ hypersensitivity reaction to a penicillin, cefepime plus vancomycin (at the dosages above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For patients who have had a severe immediate¹ hypersensitivity reaction to a penicillin in whom cefepime plus vancomycin is not used, or for patients who have had a severe delayed² hypersensitivity reaction to a penicillin, seek expert advice.

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return