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.