Antibiotics for brain abscesses in people with cyanotic congenital heart disease

Antibiotics for brain abscesses in people with cyanotic congenital heart disease

Serious congenital heart disease leads to abnormal blood flow through the heart and lungs. This results in an inability to carry enough oxygen around the body which makes patients blue (cyanotic) and severely limits their physical activity. People with cyanotic congenital heart disease are at risk of developing brain abscess. This condition is serious and can lead to death because the abscess causes abnormal brain function. Treatment includes antibiotic therapy to kill the bacteria that cause the infection. In people with a large abscess, an operation to drain the abscess may be carried out. Antibiotic therapy for brain abscess should include drugs that penetrate into the abscess cavity. The drugs chosen should also be matched to the sensitivity of the bacteria obtained from the abscess in laboratory culture. There is no evidence from randomized controlled trials to show the best antibiotic regimen for treating people with cyanotic congenital heart disease who develop brain abscess.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 1, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Lumbiganon P, Chaikitpinyo A. Antibiotics for brain abscesses in people with cyanotic congenital heart disease. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004469. DOI: 10.1002/14651858.CD004469.pub2.

This version first published online: July 18. 2007

Abstract

Background

Brain abscess is a focal, intracerebral infection that begins as a localized area of brain infection and develops into a collection of pus surrounded by a well-vascularized capsule. People with cyanotic congenital heart disease are at risk of developing brain abscess.

Objectives

To evaluate the effectiveness of antibiotic regimens for treating brain abscess in people with cyanotic congenital heart disease.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library 2006, Issue 2, MEDLINE (January 1966 to June 2006), EMBASE (January 1998 to June 2006), and LILACS (accessed in June 2006). No language or publication restrictions were used.

Selection criteria

Randomized controlled trials that reported clinically meaningful outcomes and presented results on an intention to treat basis, irrespective of blinding, publication status, or language.

Data collection and analysis

Data were to be extracted, unblinded, by the two reviewers independently. The search identified 489 articles of which 152 were articles on brain abscess. Most of the articles were case series and case reports.

Main results

No studies that met the inclusion criteria were identified.

Authors' conclusions

There are no randomized controlled trials about the effectiveness of antibiotic regimens for treating people with cyanotic congenital heart disease who developed a brain abscess. Currently, the antibiotic regimens used are based on previous retrospective studies and clinical experience. There is a need for a well designed multicentre randomized controlled trial to evaluate the effects of different antibiotic regimens.