Epidural abscess

- Infectious complication of:

  • endocarditis
  • vertebral osteomyelitis
  • psoas muscle abscess.


- Symptoms:

  • back/neck (cervical) pain
  • neurologic deficit (motor weakness, radiculopathy, bladder/bowel dysfunction)
  • fever

- MRI – emergent if progressive neurological deficit

- Blood cultures

- Usually requires urgent surgical intervention. Medical therapy alone may be considered if the patient is not a surgical candidate AND has no neurologic deficit and/or shows improvement in symptoms.

- Treat according to C&S results of blood cultures or CT-guided aspirate of abscess. If cultures are positive for Gram positive cocci in clusters/clumps, use vancomycin + cloxacillin until susceptibilities available.

Usual Pathogens

S. aureus/MRSA

Streptococcus spp
P. aeruginosa




- TB, depending on epidemiology

- Candida/fungal if spinal instrumentation or injection


Empiric Therapy Dose Duration
Vancomycin 15mg/kg IV q8-12h 6 weeks
Ceftriaxone 2g IV q12h