Listeriosis medical therapy

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

Overview

Ampicillin, with or without gentamicin, is the preferred antibiotic for the treatment of listeriosis. Patients intolerant to penicillins may be managed with 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 rhombencephalitis 6 weeks.

Principles of Therapy

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

• 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.

• The table below describes the recommended duration of therapy based upon the clinical syndrome:

Clinical Syndrome	Duration of 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

Antibiotic Therapy for Listeria monocytogenes

Antimicrobial regimen

• 1. Meningitis

• 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