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Treatment: Listerial Infections

  • Ampicillin (2 g IV q6h) is the drug of choice for the treatment of listerial infections; penicillin is also highly active.
    • - Many experts recommend the addition of gentamicin (1.0-1.7 mg/kg IV q8h) for synergy.
    • - For penicillin-allergic pts, trimethoprim-sulfamethoxazole (15-20 mg of TMP/kg IV daily in divided doses q6-8h) should be given. Cephalosporins are not effective.
    • - Neonates should receive ampicillin and gentamicin, dosed by weight.
  • The duration of therapy depends on the syndrome: 2 weeks for bacteremia, 3 weeks for meningitis, 6-8 weeks for brain abscess/encephalitis, and 4-6 weeks for endocarditis. Early-onset neonatal disease can be severe and requires treatment for >2 weeks.

For a more detailed discussion, see Pollard AJ: Meningococcal Infections, Chap. 180, p. 995; Hohmann EL, Portnoy DA: Listeria monocytogenes Infections, Chap. 176, p. 982, in HPIM-19.

Outline

Section 7. Infectious Diseases