Listeriosis medical therapy: Difference between revisions

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Latest revision as of 22:31, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

All patients with listeriosis require antibiotic therapy. Ampicillin, with or without gentamicin, is the antibiotic of choice for the treatment of listeriosis. Patients intolerant to penicillins may be managed with trimethoprim-sulfamethoxazole. Duration of therapy depends on the clinical syndrome and may range from several days in non-complicated gastroenteritis to 6 weeks in endocarditis or encephalitis. Listerial gastroenteritis is frequently self-limited among healthy adults, but a short course of oral ampicillin may be considered among immunocompromised or pregnant individuals or those who have ingested food implicated in outbreaks. Non-gastroenteritis listeriosis often require hospitalization and intravenous (IV) antibiotic therapy.

Medical Therapy

Either Ampicillin, amoxicillin, or penicillin G is effective for the treatment of listeriosis.
Addition of an aminoglycoside, which confers synergistic bactericidal effects to ampicillin, is recommended for the treatment of listerial bacteremia, endocarditis, brain abscess, meningitis, or rhombencephalitis.^[1]
Alternatively, for patients unable to tolerate beta-lactams, trimethoprim-sulfamethoxazole may be administered.

The table below describes the recommended duration of therapy based upon the clinical syndrome:^[2]^[3]

Listeriosis Clinical Syndrome	Duration of Antibiotic Therapy
Gastroenteritis, if indicated	Several days
Listeriosis in pregnancy	2 weeks
Listeriosis in neonates	2 weeks
Meningitis	2–3 weeks
Bacteremia	2–4 weeks
Endocarditis	4–6 weeks
Non-CNS listeriosis in immunocompromised hosts	4–6 weeks
Brain abscess or rhombencephalitis	6 weeks

Antimicrobial Regimen

1. Meningitis ^[4]

Preferred regimen: Ampicillin 2g IV q4-6h ± Gentamicin 1.7 mg/kg IV q8h for more than 3 weeks
Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) IV q6h for more than 3 weeks

2. Bacteremia

Preferred regimen: Ampicillin 2g IV q4-6h ± Gentamicin 1.7 mg/kg IV q8h for 2 weeks
Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 2 weeks

3. Brain abscess or rhomboencephalitis

Preferred regimen: Ampicillin 2g IV q4-6h ± Gentamicin 1.7 mg/kg IV q8h for 4-6 weeks
Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 4-6 weeks

4. Gastroenteritis

Preferred regimen (1): Amoxicillin 2g IV q4-6h
Preferred regimen (2): TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 7 days

References

↑ Gellin, B. G. (1989-03-03). "Listeriosis". JAMA: the journal of the American Medical Association. 261 (9): 1313–1320. ISSN 0098-7484. PMID 2492614. Unknown parameter |coauthors= ignored (help)
↑ Lorber, B. (1997-01). "Listeriosis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 24 (1): 1–9, quiz 10-11. ISSN 1058-4838. PMID 8994747. Check date values in: |date= (help)
↑ Gellin, B. G. (1989-03-03). "Listeriosis". JAMA: the journal of the American Medical Association. 261 (9): 1313–1320. ISSN 0098-7484. PMID 2492614. Unknown parameter |coauthors= ignored (help)
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

Template:WH Template:WS

[1] Gellin, B. G. (1989-03-03). "Listeriosis". JAMA: the journal of the American Medical Association. 261 (9): 1313–1320. ISSN 0098-7484. PMID 2492614. Unknown parameter |coauthors= ignored (help)

[2] Lorber, B. (1997-01). "Listeriosis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 24 (1): 1–9, quiz 10-11. ISSN 1058-4838. PMID 8994747. Check date values in: |date= (help)

[3] Gellin, B. G. (1989-03-03). "Listeriosis". JAMA: the journal of the American Medical Association. 261 (9): 1313–1320. ISSN 0098-7484. PMID 2492614. Unknown parameter |coauthors= ignored (help)

[4] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[1]

[2]

[3]

[4]

@@ Line 4: / Line 4: @@
 ==Overview==
+All patients with listeriosis require [[antibiotic therapy]]. [[Ampicillin]], with or without [[gentamicin]], is the [[antibiotic]] of choice for the treatment of listeriosis. Patients intolerant to [[penicillin]]s may be managed with [[TMP/SMZ|trimethoprim-sulfamethoxazole]]. Duration of therapy depends on the clinical syndrome and may range from several days in non-complicated gastroenteritis to 6 weeks in [[endocarditis]] or [[encephalitis]]. Listerial [[gastroenteritis]] is frequently self-limited among healthy adults, but a short course of oral [[ampicillin]] may be considered among [[immunocompromised]] or [[pregnant]] individuals or those who have ingested food implicated in outbreaks. Non-gastroenteritis listeriosis often require hospitalization and [[Intravenous|intravenous (IV)]] [[antibiotic]] therapy.
-[[Ampicillin]], with or without [[gentamicin]], is the preferred antibiotic for the treatment of listeriosis. Patients intolerant to [[penicillin]]s may be managed with [[TMP/SMZ|trimethoprim-sulfamethoxazole]].  The suggested minimum duration of therapy depends on the clinical syndrome.  Listerial [[gastroenteritis]] is frequently self-limited but a short course of oral [[ampicillin]] may be considered in individuals with impaired [[cell-mediated immunity]] or those who have ingested food implicated in outbreaks.  Listeria [[bacteremia]] requires at least 2 weeks of treatment, [[meningitis]] 3 weeks, [[endocarditis]] 4 to 6 weeks, and [[brain abscess]] or [[encephalitis|rhombencephalitis]] 6 weeks.
+==Medical Therapy==
+* '''Either [[Ampicillin]], [[amoxicillin]], or [[penicillin G]] is effective for the treatment of listeriosis.'''
-==Principles of Therapy==
+*Addition of an [[aminoglycoside]], which confers [[synergistic]] [[bactericidal]] effects to [[ampicillin]], is recommended for the treatment of listerial [[bacteremia]], [[endocarditis]], [[brain abscess]], [[meningitis]], or [[encephalitis|rhombencephalitis]].<ref>{{Cite journal | issn = 0098-7484 | volume = 261 | issue = 9 | pages = 1313–1320 | last = Gellin | first = B. G. | coauthors = C. V. Broome | title = Listeriosis | journal = JAMA: the journal of the American Medical Association | date = 1989-03-03 | pmid = 2492614 }}</ref>
+*Alternatively, for patients unable to tolerate [[beta-lactam]]s, [[TMP/SMZ|trimethoprim-sulfamethoxazole]] may be administered.
-* [[Ampicillin]], [[amoxicillin]], and [[penicillin G]] have been considered effective for listeriosis. For patients unable to tolerate [[beta-lactam]]s, [[TMP/SMZ|trimethoprim-sulfamethoxazole]] may be administered alternatively. [[Chloramphenicol]] is not regarded as an acceptable option due to high treatment failure and relapse rates.<ref>{{Cite journal | issn = 0162-0886 | volume = 4 | issue = 3 | pages = 665–682 | last = Stamm | first = A. M. | coauthors = W. E. Dismukes, B. P. Simmons, C. G. Cobbs, A. Elliott, P. Budrich, J. Harmon | title = Listeriosis in renal transplant recipients: report of an outbreak and review of 102 cases | journal = Reviews of Infectious Diseases | date = 1982-06 | pmid = 6750737 }}</ref>  Addition of an [[aminoglycoside]], which confers [[synergistic]] [[bactericidal]] effects to [[ampicillin]], is recommended for the treatment of listerial [[bacteremia]], [[endocarditis]], [[brain abscess]], [[meningitis]], or [[encephalitis|rhombencephalitis]].<ref>{{Cite journal | issn = 0098-7484 | volume = 261 | issue = 9 | pages = 1313–1320 | last = Gellin | first = B. G. | coauthors = C. V. Broome | title = Listeriosis | journal = JAMA: the journal of the American Medical Association | date = 1989-03-03 | pmid = 2492614 }}</ref>
-* [[Meningitis]] is the most common clinical manifestation, and antibiotics that penetrate well into the [[cerebrospinal fluid]] should be chosen.  [[Gastroenteritis]] caused by ''[[Listeria monocytogenes]]'' is usually self-limited and complete recovery typically occurs within 2 days. Persons who have ingested food implicated in outbreaks and who have a high risk of invasive illness may be treated with oral [[ampicillin]] or [[TMP/SMZ|trimethoprim-sulfamethoxazole]] for several days.<ref>{{Cite journal | issn = 1058-4838 | volume = 24 | issue = 1 | pages = 1–9; quiz 10-11 | last = Lorber | first = B. | title = Listeriosis | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 1997-01 | pmid = 8994747 }}</ref>
 * The table below describes the recommended duration of therapy based upon the clinical syndrome:<ref>{{Cite journal | issn = 1058-4838 | volume = 24 | issue = 1 | pages = 1–9; quiz 10-11 | last = Lorber | first = B. | title = Listeriosis | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 1997-01 | pmid = 8994747 }}</ref><ref>{{Cite journal | issn = 0098-7484 | volume = 261 | issue = 9 | pages = 1313–1320 | last = Gellin | first = B. G. | coauthors = C. V. Broome | title = Listeriosis | journal = JAMA: the journal of the American Medical Association | date = 1989-03-03 | pmid = 2492614 }}</ref>
 {| style="border: 0px; font-size: 90%; margin: 0 18px;"
-| style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Clinical Syndrome
+| style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Listeriosis Clinical Syndrome
-| style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Duration of Therapy
+| style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Duration of Antibiotic Therapy
 |-
 | style="background: #DCDCDC; padding: 5px 5px;" | Gastroenteritis, if indicated
@@ Line 44: / Line 41: @@
 |}
-==Antibiotic Therapy for ''Listeria monocytogenes'' <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Clin Infect Dis. 1997;24(1):1-9.'',<ref>{{Cite journal | issn = 1058-4838 | volume = 24 | issue = 1 | pages = 1–9; quiz 10-11 | last = Lorber | first = B. | title = Listeriosis | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 1997-01 | pmid = 8994747 }}</ref> ''Clin Infect Dis. 2005;40(9):1327-32.'',<ref>{{Cite journal | doi = 10.1086/429324 | issn = 1537-6591 | volume = 40 | issue = 9 | pages = 1327–1332 | last = Ooi | first = Say Tat | coauthors = Bennett Lorber | title = Gastroenteritis due to Listeria monocytogenes | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 2005-05-01 | pmid = 15825036 }}</ref> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref>{{Cite journal | doi = 10.1086/425368 | issn = 1537-6591 | volume = 39 | issue = 9 | pages = 1267–1284 | last = Tunkel | first = Allan R. | coauthors = Barry J. Hartman, Sheldon L. Kaplan, Bruce A. Kaufman, Karen L. Roos, W. Michael Scheld, Richard J. Whitley | title = Practice guidelines for the management of bacterial meningitis | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 2004-11-01 | pmid = 15494903 }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
+===Antimicrobial Regimen===
+*1. '''Meningitis''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-* <font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
+:* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for more than 3 weeks
-<div style="-webkit-user-select: none;">
+:* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) IV q6h for more than 3 weeks
-{|
+*2. '''Bacteremia'''
-| valign=top |
+:* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 2 weeks
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center; margin: 0 18px;">
+:* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 2 weeks
-<font color="#FFF">
+*3. '''Brain abscess or rhomboencephalitis'''
-'''''L. monocytogenes''''' '''Infections'''
+:* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 4-6 weeks
-</font>
+:* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 4-6 weeks
-</div>
+*4. '''Gastroenteritis'''
-<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;">
+:* Preferred regimen (1): [[Amoxicillin]] 2g IV q4-6h
-<font color="#FFF">
+:* Preferred regimen (2): [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 7 days
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Bacteremia'''
-</font>
-</div>
-<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Brain Abscess'''
-</font>
-</div>
-<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Endocarditis'''
-</font>
-</div>
-<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gastroenteritis'''
-</font>
-</div>
-<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Meningitis'''
-</font>
-</div>
-<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Rhombencephalitis'''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes'', Bacteremia<sup>¶</sup>}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2 mg/kg IV load, then 1.7 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 10—20 mg/kg/day IV q6—12h''''' (TMP component)<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <sup>¶</sup><SMALL> '''Minimum duration of therapy: 2 weeks''' </SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes'', Brain Abscess<sup>†</sup>}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2 mg/kg IV load, then 1.7 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 10—20 mg/kg/day IV q6—12h''''' (TMP component)<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <sup>†</sup><SMALL> '''Minimum duration of therapy: 6 weeks''' </SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes'', Endocarditis<sup>§</sup>}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2 mg/kg IV load, then 1.7 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 10—20 mg/kg/day IV q6—12h''''' (TMP component)<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <sup>§</sup><SMALL> '''Minimum duration of therapy: 4—6 weeks''' </SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes'', Gastroenteritis}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ Antimicrobial therapy is <u>'''not'''</u> warranted in most cases.
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen''''' <BR> <SMALL> (For Outbreaks and Invasive Diseases) </SMALL>
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 500 mg PO q6h x 5 days'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 160/800 mg PO q12h x 5 days'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes'', Meningitis<sup>‡</sup>}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2 mg/kg IV load, then 1.7 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 10—20 mg/kg/day IV q6—12h''''' (TMP component)<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <sup>‡</sup><SMALL> '''Minimum duration of therapy: 3 weeks''' </SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes'', Rhombencephalitis<sup>†</sup>}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2 mg/kg IV load, then 1.7 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 10—20 mg/kg/day IV q6—12h''''' (TMP component)<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <sup>†</sup><SMALL> '''Minimum duration of therapy: 6 weeks''' </SMALL>
-|-
-|}
-|}
-|}</div>
 ==References==
@@ Line 212: / Line 59: @@
 {{reflist|2}}
-[[Category:Bacterial diseases]]
+{{WH}}
+{{WS}}
+[[Category:Emergency mdicine]]
 [[Category:Disease]]
+[[Category:Up-To-Date]]
 [[Category:Infectious disease]]
+[[Category:Neurology]]
+[[Category:Gastroenterology]]