Do you use standard dose or "meningitis dosing" of antibiotics when treating epidural abscesses, in the absence of CNS symptoms?  

Not always. While I will use meningitis dosing for initial therapy, I have no qualms about using cefazolin for MSSA (and several recent publications support this), nor using ceftriaxone 2g/d for streptococcal infection. And frequently after the initial 3-4 weeks on IV, I transition to oral doxycycli...

Of course, I use meningitis-type dosing in patients with SEA or suspected SEA. Why wouldn't I? It's not to penetrate the meninges; it's a coincidence. For any abscess, I use increased dosing to penetrate the abscess. I agree with Dr. @Bradsher. Most SEAs I have treated are secondary to aureus. And, ...

I do use meningitis-type dosing of antibiotics when treating epidural abscesses because of the concern of localized meningitis in the epidural space. Since many or most epidural abscesses that I have taken care of are from Staph aureus, I have traditionally used Nafcillin or Oxacillin if MSSA and Va...

Meningitis dosing.

I use "meningitis dosing" for epidural abscess - not because of my concern for meningitis, but because these infections often begin in the disc space, spread to the end plates of the vertebral bodies, then out to form abscess, assuming this is not a post-neurosurgery abscess. We do not have neurosur...