Listeriosis medical therapy
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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.