Treatment of Invasive Listeriosis with Impaired Immunity, Meningitis, or Endocarditis
This protocol covers invasive listeriosis in patients with impaired immunity — including neonates — as well as cases complicated by meningitis or endocarditis, in patients who are not allergic to penicillins.
Clinical Scenario
Invasive listeriosis presenting in a patient with impaired immunity (including neonates), or with confirmed meningitis, or with endocarditis. Penicillin allergy has been excluded. Expert consensus supports combination antibiotic therapy across all of these presentations.
Treatment Approach — Partial Overview
High-dose ampicillin is the preferred agent, with penicillin G considered a likely equivalent alternative. An aminoglycoside is added to the regimen — particularly for patients with impaired immunity (including neonates) and for all cases of meningitis or endocarditis — and is discontinued once the patient's condition improves. Duration of therapy is calibrated to the specific presentation.
Partial overview only — full regimen available below
References
- Most experts recommend adding gentamicin to ampicillin therapy for the treatment of bacteraemia in persons with impaired immunity (including neonates), and all cases of meningitis and endocarditis.
- High dose antimicrobial therapy should be used in all cases of bacteraemia/possible bacteraemia.
- Ampicillin is the preferred agent, although penicillin is likely to be as effective.
- Gentamicin is discontinued once the patient improves.
- Bacteremic patients without CSF abnormalities can be treated for 2 weeks; meningitis should be treated for 3 weeks; relapses have been documented with shorter durations of therapy.
- Longer durations of therapy are needed for encephalitis, brain abscess and endocarditis, and should be considered in any invasive infection in an immunocompromised person.
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