Sandbox Listeriosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Overview

Ampicillin, with or without gentamicin, is considered the drug of choice for listeriosis. Patients intolerant of penicillins may be managed with trimethoprim-sulfamethoxazole alternatively. Suggested minimum duration of therapy depends on clinical manifestations: bacteremia should be treated for 2 weeks, meningitis for 3 weeks, endocarditis for 4 to 6 weeks, and brain abscess or rhomboencephalitis for at least 6 weeks.

Principles of Therapy

• Ampicillin, amoxicillin, and penicillin G have been considered effective for listeriosis. For patients unable to tolerate beta-lactams, trimethoprim-sulfamethoxazole may be used alternatively. Chloramphenicol is not regarded as an acceptable option due to high treatment failure and relapse rates.

• Addition of an aminoglycoside, which provides synergistic bactericidal effects to ampicillin, is generally recommended for the treatment of listerial bacteremia, endocarditis, brain abscess, meningitis, or rhomboencephalitis.

• Bacteremia should be treated for 2 weeks, meningitis for 3 weeks, endocarditis for 4 to 6 weeks, and brain abscess or rhomboencephalitis for at least 6 weeks.

• Meningitis is the most common clinical manifestation, and antibiotics that penetrate well into the CSF should be chosen.

• Gastroenteritis caused by Listeria monocytogenes is usually self-limited and complete recovery typically occurs within 2 days. Patients who have ingested food implicated in outbreaks and who have a high risk of invasive illness may consider oral herapy with ampicillin or trimethoprim-sulfamethoxazole for several days.

Medical Therapy for Listeria monocytogenes Adapted from Clin Infect Dis. 1997;24(1):1-9., Clin Infect Dis. 2005;40(9):1327-32., and Clin Infect Dis. 2004;39(9):1267-84.

▸ Click on the following categories to expand treatment regimens.

L. monocytogenes Infections   ▸  Bacteremia   ▸  Brain Abscess   ▸  Endocarditis   ▸  Gastroenteritis   ▸  Meningitis   ▸  Rhombencephalitis

Listeria monocytogenes, Bacteremia¶ Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 2 mg/kg IV load, then 1.7 mg/kg IV q8h Alternative Regimen ▸ TMP/SMZ 10—20 mg/kg/day IV q6—12h (TMP component) OR ▸ Meropenem 2 g IV q8h ¶ Minimum duration of therapy: 2 weeks Listeria monocytogenes, Brain Abscess† Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 2 mg/kg IV load, then 1.7 mg/kg IV q8h Alternative Regimen ▸ TMP/SMZ 10—20 mg/kg/day IV q6—12h (TMP component) OR ▸ Meropenem 2 g IV q8h † Minimum duration of therapy: 6 weeks Listeria monocytogenes, Endocarditis§ Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 2 mg/kg IV load, then 1.7 mg/kg IV q8h Alternative Regimen ▸ TMP/SMZ 10—20 mg/kg/day IV q6—12h (TMP component) OR ▸ Meropenem 2 g IV q8h § Minimum duration of therapy: 4—6 weeks Listeria monocytogenes, Gastroenteritis Preferred Regimen ▸ Antimicrobial therapy is not warranted in most cases. Alternative Regimen (For Outbreaks and Invasive Diseases) ▸ Ampicillin 500 mg PO q6h x 5 days OR ▸ TMP/SMZ 160/800 mg PO q12h x 5 days Listeria monocytogenes, Meningitis‡ Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 2 mg/kg IV load, then 1.7 mg/kg IV q8h Alternative Regimen ▸ TMP/SMZ 10—20 mg/kg/day IV q6—12h (TMP component) OR ▸ Meropenem 2 g IV q8h ‡ Minimum duration of therapy: 3 weeks Listeria monocytogenes, Rhombencephalitis† Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 2 mg/kg IV load, then 1.7 mg/kg IV q8h Alternative Regimen ▸ TMP/SMZ 10—20 mg/kg/day IV q6—12h (TMP component) OR ▸ Meropenem 2 g IV q8h † Minimum duration of therapy: 6 weeks