An elderly male presented with headache, fever and hemiparasis of right side. On further examination and investigation, a diagnosis of brain abscess was made. Which of the following antibacterial/ antibacterials is effective in this patient:

Ans. d. A combination of cephalosporin and metronidazole (Ref: Harrison 19/e p900, 18/e p3429-3430; Sabiston 19/e p1913; Schwartz 9/e p1550; Bailey 26/e p609-610, 25/e p628-629)Empirical therapy of community-acquired brain abscess in an immunocompetent patient typically includes a third-or fourth-generation cephalosporin (e.g. cefotaxime, ceftriaxone or cefepime) and metronidazole.''Optimal therapy of a brain abscess involves a combination of high dose parenteral antibiotics and neurosurgical drainage. Empirical therapy of community-acquired brain abscess in an immunocompetent patient typically includes a third-or fourth-generation cephalosporin (e.g. cefotaxime, ceftriaxone or cefepime) and metronidazole."- Harrison 18/e p3429Brain AbscessIntracerebral abscess may occur as a result of direct spread from air sinus infection, following surgery or from hematogenous spread especially associated with respiratory infection, endocarditis or dental infectionQ.Increased risk of abscess in: Cyanotic heart disease, immunocompromised (diabetes, solid organ transplant, hematological malignancy or long-term steroids)QOrganisms: Streptococci (MC), Bacteroides, Pseudomonas, Hemophilus and EnterobacteriaceaeEtiologyLocationOtitis media, mastoiditis* Temporal lobeQ >CerebellumParanasal sinusitis, dental infections* Frontal lobesQHematogenous* Parietal lobeQClinical Features:Presentation is with focal signs, seizures and raised ICP, as with other mass lesions, but the time course is often shortQ.Patients may be febrile or have a raised peripheral white cell count or inflammatory markers.Diagnosis:CT scan: Ring-enhancing mass lesion (may be multiple in case of hematogenous spread)Q Treatment:Surgical drainage + IV antibiotics for at least 6 weeksQ.Multiple small abscesses may be treated medically with antibiotics targeted against organismsSteroids are reserved for cases with significant edema or mass effectQOwing to the high risk of seizures, patients should also be treated with anticonvulsants.Optimal therapy of a brain abscess involves a combination of high dose parenteral antibiotics and neurosurgical drainage.Empirical therapy of community-acquired brain abscess in an immunocompetent patient typically includes a third-or fourth-generation cephalosporin (e.g. cefotaxime, ceftriaxone or cefepime) and metronidazole.