Listeriosis medical therapy: Difference between revisions
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==Overview== | |||
[[Ampicillin]], with or without [[gentamicin]], is considered the drug of choice for listeriosis. Patients intolerant of [[penicillin]]s may be managed with [[TMP/SMZ|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-lactam]]s, [[TMP/SMZ|trimethoprim-sulfamethoxazole]] may be used alternatively. [[Chloramphenicol]] is not regarded as an acceptable option due to high treatment failure and relapse rates.<ref name="Stamm-">{{Cite journal | last1 = Stamm | first1 = AM. | last2 = Dismukes | first2 = WE. | last3 = Simmons | first3 = BP. | last4 = Cobbs | first4 = CG. | last5 = Elliott | first5 = A. | last6 = Budrich | first6 = P. | last7 = Harmon | first7 = J. | title = Listeriosis in renal transplant recipients: report of an outbreak and review of 102 cases. | journal = Rev Infect Dis | volume = 4 | issue = 3 | pages = 665-82 | month = | year = | doi = | PMID = 6750737 }}</ref> | |||
== | * 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.<ref name="Gellin-1989">{{Cite journal | last1 = Gellin | first1 = BG. | last2 = Broome | first2 = CV. | title = Listeriosis. | journal = JAMA | volume = 261 | issue = 9 | pages = 1313-20 | month = Mar | year = 1989 | doi = | PMID = 2492614 }}</ref> | ||
[[Bacteremia]] should be treated for 2 weeks, [[meningitis]] for 3 weeks, and [[brain abscess]] for at least 6 weeks. [[ | |||
* [[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. Persons who have ingested food implicated in outbreaks and who have a high risk of invasive illness may consider oral herapy with [[ampicillin]] or [[TMP/SMZ|trimethoprim-sulfamethoxazole]] for several days.<ref name="Lorber-1997">{{Cite journal | last1 = Lorber | first1 = B. | title = Listeriosis. | journal = Clin Infect Dis | volume = 24 | issue = 1 | pages = 1-9; quiz 10-1 | month = Jan | year = 1997 | doi = | PMID = 8994747 }}</ref> | |||
==Medical Therapy for ''Listeria monocytogenes'' <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Clin Infect Dis. 1997;24(1):1-9.'',<ref name="Lorber-1997">{{Cite journal | last1 = Lorber | first1 = B. | title = Listeriosis. | journal = Clin Infect Dis | volume = 24 | issue = 1 | pages = 1-9; quiz 10-1 | month = Jan | year = 1997 | doi = | PMID = 8994747 }}</ref> ''Clin Infect Dis. 2005;40(9):1327-32.'',<ref name="Ooi-2005">{{Cite journal | last1 = Ooi | first1 = ST. | last2 = Lorber | first2 = B. | title = Gastroenteritis due to Listeria monocytogenes. | journal = Clin Infect Dis | volume = 40 | issue = 9 | pages = 1327-32 | month = May | year = 2005 | doi = 10.1086/429324 | PMID = 15825036 }}</ref> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | |||
= | <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | ||
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<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;"> | |||
<font color="#FFF"> | |||
'''''L. monocytogenes''''' '''Infections''' | |||
</font> | |||
</div> | |||
<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;"> | |||
<font color="#FFF"> | |||
▸ '''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;"> | |||
<font color="#FFF"> | |||
▸ '''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;"> | |||
<font color="#FFF"> | |||
▸ '''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;"> | |||
<font color="#FFF"> | |||
▸ '''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;"> | |||
<font color="#FFF"> | |||
▸ '''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;"> | |||
<font color="#FFF"> | |||
▸ '''Rhombencephalitis''' | |||
</font> | |||
</div> | |||
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{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;" | |||
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{| 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> | |||
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|} | |||
|} | |||
{| 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> | |||
|- | |||
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{| 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> | |||
|- | |||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Wikifect]] |
Revision as of 19:02, 23 February 2014
Listeriosis Microchapters |
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Listeriosis medical therapy On the Web |
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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.[1]
- 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.[2]
- 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. Persons 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.[3]
Medical Therapy for Listeria monocytogenes Adapted from Clin Infect Dis. 1997;24(1):1-9.,[3] Clin Infect Dis. 2005;40(9):1327-32.,[4] and Clin Infect Dis. 2004;39(9):1267-84.[5]
▸ Click on the following categories to expand treatment regimens.
L. monocytogenes Infections ▸ Bacteremia ▸ Brain Abscess ▸ Endocarditis ▸ Gastroenteritis ▸ Meningitis ▸ Rhombencephalitis |
|
References
- ↑ Stamm, AM.; Dismukes, WE.; Simmons, BP.; Cobbs, CG.; Elliott, A.; Budrich, P.; Harmon, J. "Listeriosis in renal transplant recipients: report of an outbreak and review of 102 cases". Rev Infect Dis. 4 (3): 665–82. PMID 6750737.
- ↑ Gellin, BG.; Broome, CV. (1989). "Listeriosis". JAMA. 261 (9): 1313–20. PMID 2492614. Unknown parameter
|month=
ignored (help) - ↑ 3.0 3.1 Lorber, B. (1997). "Listeriosis". Clin Infect Dis. 24 (1): 1–9, quiz 10-1. PMID 8994747. Unknown parameter
|month=
ignored (help) - ↑ Ooi, ST.; Lorber, B. (2005). "Gastroenteritis due to Listeria monocytogenes". Clin Infect Dis. 40 (9): 1327–32. doi:10.1086/429324. PMID 15825036. Unknown parameter
|month=
ignored (help) - ↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: [1]