Sandbox Listeriosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Overview

Ampicillin and penicillin G are generally recommended for treatment of Listeria monocytogenes because of its resistance to cephalosporins. Bacteremia should be treated for 2 weeks, meningitis for 3 weeks, endocarditis for 4 weeks, and brain abscess or rhomboencephalitis for at least 6 weeks. Overall mortality rate is 20-30%; of all pregnancy-related cases, 22% resulted in fetal loss or neonatal death, but mothers usually survive.

Principles of Therapy

• 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.

• Ampicillin is considered the treatment of choice for listeriosis. For patients unable to tolerate penicillins, trimethoprim-sulfamethoxazole can be used alternatively. Chloramphenicol is not regarded as an acceptable option due to high treatment failure and relapse rates.

Medical Therapy for Listeria monocytogenes Adapted from Clin Infect Dis. 1997;24(1):1-9., Clin Infect Dis. 2005;40(9):1327-32., and Clin Infect Dis. 2004;39(9):1267-84.

▸ 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