Listeriosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
[[Ampicillin]], with or without [[gentamicin]], is considered the drug of choice for listeriosis. Patients intolerant to [[penicillin]]s may be managed with [[TMP/SMZ|trimethoprim-sulfamethoxazole]]. The suggested minimum duration of therapy depends on the clinical syndrome: [[bacteremia]] requires 2 weeks of treatment, [[meningitis]] 3 weeks, [[endocarditis]] 4 to 6 weeks, and [[brain abscess]] or [[encephalitis|rhombencephalitis]] | [[Ampicillin]], with or without [[gentamicin]], is considered the drug of choice for listeriosis. Patients intolerant to [[penicillin]]s may be managed with [[TMP/SMZ|trimethoprim-sulfamethoxazole]]. The suggested minimum duration of therapy depends on the clinical syndrome: [[bacteremia]] requires at least 2 weeks of treatment, [[meningitis]] 3 weeks, [[endocarditis]] 4 to 6 weeks, and [[brain abscess]] or [[encephalitis|rhombencephalitis]] 6 weeks. For listerial [[gastroenteritis]], which is frequently self-limited, a short course of oral [[ampicillin]] may be administered to individuals who have ingested food implicated in outbreaks or who have impaired [[cell-mediated immunity]]. | ||
==Principles of Therapy== | ==Principles of Therapy== | ||
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* 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.<ref>{{Cite journal | issn = 0098-7484 | volume = 261 | issue = 9 | pages = 1313–1320 | last = Gellin | first = B. G. | coauthors = C. V. Broome | title = Listeriosis | journal = JAMA: the journal of the American Medical Association | date = 1989-03-03 | pmid = 2492614 }}</ref> | * 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.<ref>{{Cite journal | issn = 0098-7484 | volume = 261 | issue = 9 | pages = 1313–1320 | last = Gellin | first = B. G. | coauthors = C. V. Broome | title = Listeriosis | journal = JAMA: the journal of the American Medical Association | date = 1989-03-03 | pmid = 2492614 }}</ref> | ||
* [[Meningitis]] is the most common clinical manifestation, and antibiotics that penetrate well into the [[cerebrospinal fluid]] should be chosen. | * [[Meningitis]] is the most common clinical manifestation, and antibiotics that penetrate well into the [[cerebrospinal fluid]] should be chosen. | ||
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* [[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 [[TMP/SMZ|trimethoprim-sulfamethoxazole]] for several days.<ref>{{Cite journal | issn = 1058-4838 | volume = 24 | issue = 1 | pages = 1–9; quiz 10-11 | last = Lorber | first = B. | title = Listeriosis | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 1997-01 | pmid = 8994747 }}</ref> | * [[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 [[TMP/SMZ|trimethoprim-sulfamethoxazole]] for several days.<ref>{{Cite journal | issn = 1058-4838 | volume = 24 | issue = 1 | pages = 1–9; quiz 10-11 | last = Lorber | first = B. | title = Listeriosis | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 1997-01 | pmid = 8994747 }}</ref> | ||
{| style="border: 0px; font-size: 90%; margin: | * The table below describes the recommended duration of therapy based upon the clinical syndrome:<ref>{{Cite journal | issn = 1058-4838 | volume = 24 | issue = 1 | pages = 1–9; quiz 10-11 | last = Lorber | first = B. | title = Listeriosis | journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America | date = 1997-01 | pmid = 8994747 }}</ref><ref>{{Cite journal | issn = 0098-7484 | volume = 261 | issue = 9 | pages = 1313–1320 | last = Gellin | first = B. G. | coauthors = C. V. Broome | title = Listeriosis | journal = JAMA: the journal of the American Medical Association | date = 1989-03-03 | pmid = 2492614 }}</ref> | ||
{| style="border: 0px; font-size: 90%; margin: 0 18px;" | |||
| style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Clinical Syndrome | | style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Clinical Syndrome | ||
| style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Duration of Therapy | | style="background: #4479BA; font-weight: bold; font-style: italic; color: #FFFFFF; padding: 5px 5px;" align=center | Duration of Therapy | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px 5px;" | Gastroenteritis | | style="background: #DCDCDC; padding: 5px 5px;" | Gastroenteritis, if indicated | ||
| style="background: #F0F0F0; padding: 5px 5px;" | | | style="background: #F0F0F0; padding: 5px 5px;" | Several days | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px 5px;" | Listeriosis in pregnancy | | style="background: #DCDCDC; padding: 5px 5px;" | Listeriosis in pregnancy | ||
| style="background: #F0F0F0; padding: 5px 5px;" | | | style="background: #F0F0F0; padding: 5px 5px;" | 2 weeks | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px 5px;" | | | style="background: #DCDCDC; padding: 5px 5px;" | Listeriosis in neonates | ||
| style="background: #F0F0F0; padding: 5px 5px;" | | | style="background: #F0F0F0; padding: 5px 5px;" | 2 weeks | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px 5px;" | Meningitis | | style="background: #DCDCDC; padding: 5px 5px;" | Meningitis | ||
| style="background: #F0F0F0; padding: 5px 5px;" | | | style="background: #F0F0F0; padding: 5px 5px;" | 2–3 weeks | ||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Bacteremia | |||
| style="background: #F0F0F0; padding: 5px 5px;" | 2–4 weeks | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px 5px;" | Endocarditis | | style="background: #DCDCDC; padding: 5px 5px;" | Endocarditis | ||
| style="background: #F0F0F0; padding: 5px 5px;" | | | style="background: #F0F0F0; padding: 5px 5px;" | 4–6 weeks | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px 5px;" | Non-CNS listeriosis in immunocompromised hosts | | style="background: #DCDCDC; padding: 5px 5px;" | Non-CNS listeriosis in immunocompromised hosts | ||
| style="background: #F0F0F0; padding: 5px 5px;" | | | style="background: #F0F0F0; padding: 5px 5px;" | 4–6 weeks | ||
|- | |||
| style="background: #DCDCDC; padding: 5px 5px;" | Brain abscess or rhombencephalitis | |||
| style="background: #F0F0F0; padding: 5px 5px;" | 6 weeks | |||
|} | |} | ||
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{| | {| | ||
| valign=top | | | valign=top | | ||
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;"> | <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center; margin: 0 18px;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
'''''L. monocytogenes''''' '''Infections''' | '''''L. monocytogenes''''' '''Infections''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Bacteremia''' | ▸ '''Bacteremia''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Brain Abscess''' | ▸ '''Brain Abscess''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Endocarditis''' | ▸ '''Endocarditis''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Gastroenteritis''' | ▸ '''Gastroenteritis''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | <div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Meningitis''' | ▸ '''Meningitis''' | ||
</font> | </font> | ||
</div> | </div> | ||
<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;"> | <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA; margin: 0 18px;"> | ||
<font color="#FFF"> | <font color="#FFF"> | ||
▸ '''Rhombencephalitis''' | ▸ '''Rhombencephalitis''' |
Revision as of 18:07, 22 July 2014
Listeriosis Microchapters |
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Listeriosis medical therapy On the Web |
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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 to penicillins may be managed with trimethoprim-sulfamethoxazole. The suggested minimum duration of therapy depends on the clinical syndrome: bacteremia requires at least 2 weeks of treatment, meningitis 3 weeks, endocarditis 4 to 6 weeks, and brain abscess or rhombencephalitis 6 weeks. For listerial gastroenteritis, which is frequently self-limited, a short course of oral ampicillin may be administered to individuals who have ingested food implicated in outbreaks or who have impaired cell-mediated immunity.
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.[1]
- 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.[2]
- 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.[3]
- The table below describes the recommended duration of therapy based upon the clinical syndrome:[4][5]
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.,[6] Clin Infect Dis. 2005;40(9):1327-32.,[7] and Clin Infect Dis. 2004;39(9):1267-84.[8]
▸ Click on the following categories to expand treatment regimens.
L. monocytogenes Infections ▸ Bacteremia ▸ Brain Abscess ▸ Endocarditis ▸ Gastroenteritis ▸ Meningitis ▸ Rhombencephalitis |
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References
- ↑ Stamm, A. M. (1982-06). "Listeriosis in renal transplant recipients: report of an outbreak and review of 102 cases". Reviews of Infectious Diseases. 4 (3): 665–682. ISSN 0162-0886. PMID 6750737. Unknown parameter
|coauthors=
ignored (help); 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) - ↑ 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) - ↑ 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) - ↑ 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) - ↑ Ooi, Say Tat (2005-05-01). "Gastroenteritis due to Listeria monocytogenes". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 40 (9): 1327–1332. doi:10.1086/429324. ISSN 1537-6591. PMID 15825036. Unknown parameter
|coauthors=
ignored (help) - ↑ Tunkel, Allan R. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903. Unknown parameter
|coauthors=
ignored (help)