Drug Related Adverse Events During Treatment of CNS Abscess in Children

Background: Treatment of brain abscesses and other intracranial infections requires long lasting antibiotics, glucocorticoids and antiepileptic therapy. Antibiotics with good diffusion to CNS and inside abscesses are the preferred ones. Medicaments related adverse events are frequent in these patients. Generally, they force to change the planned treatment.

Objective: To describe drugs related adverse events during treatment of pediatric patients with CNS abscesses.

Methods: Retrospective single-center study of pediatric patients treated for CNS abscesses.

Results: A total of 32 patients were included in the study (2000-2018). Presented with brain abscess 31%, subdural empyema 31%, brain abscess + subdural empyema 6% and epidural abscess 25%. Age range was 1,5 months to 16 years (median 6 years). Male/female ratio was 2:1.

Usually, these patients received sequential intravenous and oral treatment. Median of duration of antibiotic treatment (intravenous + oral) was 69 days (range 40-120). Intravenous treatment median was 28 days (range 7-90 days). Received glucocorticoids 47% and antiepileptic drugs 62%.

Three patients developed neutropenia (related to linezolid and cotrimoxazole). Four patients developed exanthems. Three patients developed DRESS syndrome (one due to phenytoin and two related to antibiotics). Two patients had knee arthritis related to fluoroquinolones. One patient developed linezolid related peripheric neuropathy. Cushing syndrome was related to prolonged glucocorticoid therapy.

Conclusions: Patients treated for CNS pyogenic infections frequently develop drug related adverse events. Careful monitoring of blood counts, liver and renal function and skin disorders is mandatory.