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

• Ampicillin, amoxicillin, and penicillin G have been considered effective for listeriosis. For patients unable to tolerate beta-lactams, trimethoprim-sulfamethoxazole may be administered 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.

• 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 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