Listeriosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
[[Ampicillin]], with or without [[gentamicin]], is considered the drug of choice for 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: [[bacteremia]] requires 2 weeks of treatment, [[meningitis]] 3 weeks, [[endocarditis]] 4 to 6 weeks, and [[brain abscess]] or [[encephalitis|rhombencephalitis]] at least 6 weeks. For listerial [[gastroenteritis]], which is frequently self-limited, a short course of oral [[ampicillin]] may be administered to individuals who have ingested food implicated in outbreaks or who have | [[Ampicillin]], with or without [[gentamicin]], is considered the drug of choice for 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: [[bacteremia]] requires 2 weeks of treatment, [[meningitis]] 3 weeks, [[endocarditis]] 4 to 6 weeks, and [[brain abscess]] or [[encephalitis|rhombencephalitis]] at least 6 weeks. For listerial [[gastroenteritis]], which is frequently self-limited, a short course of oral [[ampicillin]] may be administered to individuals who have ingested food implicated in outbreaks or who have impaired [[cell-mediated immunity]]. | ||
==Principles of Therapy== | ==Principles of Therapy== | ||
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* [[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> | * [[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> | ||
== | {| style="border: 0px; font-size: 90%; margin: 0px;" | ||
| 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 | Duration of Therapy | |||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Gastroenteritis (if indicated) | |||
| style="background: #F0F0F0; padding: 5px 5px;" | Days | |||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Neonatal listeriosis | |||
| style="background: #F0F0F0; padding: 5px 5px;" | ≥2 weeks | |||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Listeriosis in pregnancy | |||
| style="background: #F0F0F0; padding: 5px 5px;" | ≥2 weeks | |||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Primary bacteremia without meningitis | |||
| style="background: #F0F0F0; padding: 5px 5px;" | ≥4 weeks | |||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Meningitis | |||
| style="background: #F0F0F0; padding: 5px 5px;" | ≥2–3 weeks | |||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Endocarditis | |||
| style="background: #F0F0F0; padding: 5px 5px;" | ≥4–6 weeks | |||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Non-CNS listeriosis in immunocompromised hosts | |||
| style="background: #F0F0F0; padding: 5px 5px;" | ≥4–6 weeks | |||
|} | |||
==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>== | |||
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> | <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL> |
Revision as of 17:40, 22 July 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Ampicillin, with or without gentamicin, is considered the drug of choice for listeriosis. Patients intolerant to penicillins may be managed with trimethoprim-sulfamethoxazole. The suggested minimum duration of therapy depends on the clinical syndrome: bacteremia requires 2 weeks of treatment, meningitis 3 weeks, endocarditis 4 to 6 weeks, and brain abscess or rhombencephalitis at least 6 weeks. For listerial gastroenteritis, which is frequently self-limited, a short course of oral ampicillin may be administered to individuals who have ingested food implicated in outbreaks or who have impaired cell-mediated immunity.
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 administered alternatively. Chloramphenicol is not regarded as an acceptable option due to high treatment failure and relapse rates.[1]
- 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.[2]
- Bacteremia should be treated for 2 weeks, meningitis for 3 weeks, endocarditis for 4 to 6 weeks, and brain abscess or rhombencephalitis for at least 6 weeks.
- 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 trimethoprim-sulfamethoxazole for several days.[3]
Clinical Syndrome | Duration of Therapy |
Gastroenteritis (if indicated) | Days |
Neonatal listeriosis | ≥2 weeks |
Listeriosis in pregnancy | ≥2 weeks |
Primary bacteremia without meningitis | ≥4 weeks |
Meningitis | ≥2–3 weeks |
Endocarditis | ≥4–6 weeks |
Non-CNS listeriosis in immunocompromised hosts | ≥4–6 weeks |
Antibiotic Therapy for Listeria monocytogenes Adapted from Clin Infect Dis. 1997;24(1):1-9.,[4] Clin Infect Dis. 2005;40(9):1327-32.,[5] and Clin Infect Dis. 2004;39(9):1267-84.[6]
▸ Click on the following categories to expand treatment regimens.
L. monocytogenes Infections ▸ Bacteremia ▸ Brain Abscess ▸ Endocarditis ▸ Gastroenteritis ▸ Meningitis ▸ Rhombencephalitis |
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References
- ↑ Stamm, A. M. (1982-06). "Listeriosis in renal transplant recipients: report of an outbreak and review of 102 cases". Reviews of Infectious Diseases. 4 (3): 665–682. ISSN 0162-0886. PMID 6750737. Unknown parameter
|coauthors=
ignored (help); 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) - ↑ 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) - ↑ 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) - ↑ Ooi, Say Tat (2005-05-01). "Gastroenteritis due to Listeria monocytogenes". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 40 (9): 1327–1332. doi:10.1086/429324. ISSN 1537-6591. PMID 15825036. Unknown parameter
|coauthors=
ignored (help) - ↑ Tunkel, Allan R. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903. Unknown parameter
|coauthors=
ignored (help)