Paper II
2020 February (Supplementary) (2010 Scheme)

Question

Metronidazole and ceftriaxone for brain abscess

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Answer

Brain abscess is often polymicrobial, typically involving a mix of anaerobic and aerobic organisms (including streptococci, and anaerobes from an oral/sinus/otogenic source). Metronidazole provides excellent anaerobic coverage and penetrates the blood-brain barrier well, while ceftriaxone (a third-generation cephalosporin) provides broad aerobic Gram-positive and Gram-negative cover with good CSF/brain tissue penetration. The combination provides broad-spectrum empirical coverage against the likely polymicrobial flora while achieving adequate concentrations at the site of infection, which is essential given the difficulty of obtaining prompt microbiological confirmation in brain abscess.

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