Listeriosis medical therapy

Listeriosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Listeriosis from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Screening
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
MRI
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Listeriosis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Listeriosis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Listeriosis medical therapy
CDC on Listeriosis medical therapy
Listeriosis medical therapy in the news
Blogs on Listeriosis medical therapy
Directions to Hospitals Treating Listeriosis
Risk calculators and risk factors for Listeriosis medical therapy

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 of penicillins may be managed with trimethoprim-sulfamethoxazole. The suggested minimum duration of therapy depends on clinical manifestations: bacteremia requires 2 weeks of treatment, meningitis 3 weeks, endocarditis 4 to 6 weeks, and brain abscess or rhombencephalitis at least 6 weeks.

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 used alternatively. 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.

• 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.

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