Successful treatment of multiple brain abscesses with antibiotics alone.

Seven adults with multiple brain abscesses were successfully treated with antibiotic therapy alone at The George Washington University Medical Center, Washington, D.C., during 1976-1981. Fever, meningismus, and focal neurologic signs were common presenting features. No patient presented with coma or obtundation. Etiologic agents were identified in only three cases. Computerized tomographic (CT) scans were valuable in diagnosing and monitoring the response to therapy. Decrease in the size of the lesions was noted two to nine weeks after initiation of antibiotic therapy. In all patients, clinical signs of improvement preceded evidence of resolution of lesions on CT scan. These results indicate that, in carefully selected patients in whom surgical drainage is not feasible because of the anatomic location and/or multiplicity of lesions, a prolonged course of high-dose intravenous antibiotics alone can lead to a successful outcome.