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; 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

  • The table below describes the recommended duration of therapy based upon the clinical syndrome:[4][5]
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 Adapted from Clin Infect Dis. 1997;24(1):1-9.,[6] Clin Infect Dis. 2005;40(9):1327-32.,[7] and Clin Infect Dis. 2004;39(9):1267-84.[8]

  • 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

References

  1. 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)
  2. 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)
  3. 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)
  4. 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)
  5. 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)
  6. 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)
  7. 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)
  8. 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)