American Board of Internal Medicine (ABIM) Certification Practice Exam

What initial treatment is recommended for a brain abscess stemming from dental sepsis?

1. Oral antibiotics only

2. Intravenous penicillin and metronidazole

3. Intramuscular antibiotics

4. Topical antibiotic creams

The correct answer is: Intravenous penicillin and metronidazole

The initial treatment for a brain abscess, especially one that originates from dental sepsis, typically involves intravenous antibiotics to ensure adequate penetration into the central nervous system. In this context, the combination of intravenous penicillin and metronidazole is highly effective. Penicillin is effective against a variety of organisms that can cause infection following dental procedures or infections, including streptococci and anaerobic bacteria commonly found in the oral cavity. Metronidazole is particularly important due to its efficacy against anaerobic bacteria, which are often involved in dental infections and can contribute to the development of a brain abscess. The choice of intravenous administration is crucial, as oral antibiotics may not achieve sufficient serum and tissue concentrations to treat a serious infection such as a brain abscess, where rapid and effective treatment is essential to prevent complications such as increased intracranial pressure or leptomeningeal spread of infection. Additionally, intramuscular antibiotics and topical antibiotic creams would not provide the necessary systemic circulation required to effectively treat an abscess in the brain. Therefore, the combination of intravenous penicillin and metronidazole is the most appropriate choice for initial management in this scenario.