Sandbox Listeriosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Bacteremia should be treated for 2 weeks, meningitis for 3 weeks, and brain abscess for at least 6 weeks.

Amoxicillin-based regimen is considered the treatment of choice for Listeria meningitis because of its resistance to cephalosporins.

Overall mortality rate is 20-30%; of all pregnancy-related cases, 22% resulted in fetal loss or neonatal death, but mothers usually survive.

Medical Therapy

• Listeriosis is treated with antibiotics. A person in a high-risk category who experiences flu-like symptoms within 2 months of eating contaminated food should seek medical care and tell the physician or health care provider about eating the contaminated food.

• If a person has eaten food contaminated with Listeria and does not have any symptoms, most experts believe that no tests or treatment are needed, even for persons at high risk for listeriosis.

Amoxicillin, ampicillin, or penicillin G is the treatment of choice for Listeria meningitis.30 Some authorities have recommended the addition of an aminoglycoside because of enhanced in-vitro killing and in-vivo synergy in animal models. No study has been done to compare amoxicillin or ampicillin alone versus amoxicillin or ampicillin plus gentamicin, although retrospective clinical data suggest that the addition of gentamicin can reduce mortality.31 By contrast, in a cohort of 118 patients with listeriosis, the aminoglycoside-treated group had increased rates of kidney injury and mortality.32 Trimethoprim-sulfamethoxazole is an alternative treat- ment in patients who are allergic to or intolerant of penicillin. In a retrospective study,33 treatment with trimethoprim-sulfamethoxazole plus ampicillin was associated with a lower antibiotic failure rate and fewer neurological sequelae than was the combination of ampicillin plus an aminoglycoside

Therapy for Listeria monocytogenes Infection Adapted from Clin Infect Dis. 1997;24(1):1-9. and Clin Infect Dis. 2005;40(9):1327-32.

▸ Click on the following categories to expand treatment regimens.

Listeria monocytogenes   ▸  Bacteremia   ▸  Brain Abscess   ▸  Endocarditis   ▸  Gastroenteritis   ▸  Meningitis   ▸  Rhombencephalitis

Listeria monocytogenes, Bacteremia Preferred Regimen ▸ Ampicillin 200 mg IV q6h x ≥2 weeks Alternative Regimen ▸ Chloramphenicol 1—1.5 g IV q6h OR ▸ Cefepime 2 g IV q8h Listeria monocytogenes, Brain Abscess Preferred Regimen ▸ Ampicillin 2 g IV q4h OR ▸ Penicillin G 4 MU IV q4h PLUS ▸ Gentamicin 1.7 mg/kg IV q8h Alternative Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Listeria monocytogenes, Endocarditis Preferred Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Penicillin G 4 MU IV q4h OR ▸ Ampicillin 2 g IV q4h OR ▸Chloramphenicol 1—1.5 g IV q6h OR ▸ Moxifloxacin 400 mg IV q24h OR ▸ Aztreonam 2 g IV q6—8h Listeria monocytogenes, Gastroenteritis Preferred Regimen ▸ Antimicrobial therapy is not warranted in most cases. Alternative Regimen (For Outbreaks and Invasive Diseases) ▸ Ampicillin 500 mg IV 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 1.7 mg/kg IV q8h Alternative Regimen ▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component) OR ▸ Meropenem2 g IV q8h