Listeriosis II

Listeriosis II

MEDICATIONS

DRUG(S) OF CHOICE:

• Neonates - IV treatment 14-21 days:
• Meningitis - for infants older than one month: ampicillin 300-400 mg/kg/day IV
• Meningitis - neonate doses: < 2000 grams, less than 1 week old: ampicillin 50 mg/kg q12h. Older than 1 week: ampicillin 50 mg/kg every 8 hours. Plus gentamicin 7.5 mg/kg/day IV for 14 days. Discontinue gentamicin when cerebro-spinal fluid is sterile.
• Alternate therapy for neonates - penicillin G 100,000-200,000 units/kg/d IV x 14-21 days plus gentamicin as above
• Bacteremia or pneumonia - ampicillin 100-150 mg/kg/day (or penicillin G 200,000 units/kg/d IV) plus gentamicin 5.0 mg/kg/day. Discontinue gentamicin when blood cultures become negative.
• Pregnant women:
• Ampicillin 2 gm IV q4h for 14-21 days plus gentamicin 120 mg IV q8h. Adjust for peak 5-6 mcg/mL.
• Immunocompromised/elderly patients:
• Ampicillin 200 mg/kg IV x 3-4 weeks. Note: Some experts recommend addition of gentamicin 3-5 mg/kg/d IV plus intrathecal doses of 4 mg q12h or combination with TMX/sulfa.
• For endocarditis and typhoidal listeriosis:
• Penicillin G 75,000-100,000 units/kg IV q4h and continue for 14 days after defervescence. plus tobramycin 2 mg/kg load, then adjust based on levels. Aim for peak at 5-6. Continue for 4 weeks after defervescence.
• For oculoglandular:
• Erythromycin 30 mg/kg/day as 4 equal doses q6h and continue for 1 week after defervescence

Contraindications: Allergy to penicillins
Precautions: Cephalosporins are not adequate treatment. Refer to manufacturer's literature.
Significant possible interactions: Refer to manufacturer's literature

ALTERNATIVE DRUGS:

• Trimethoprim-sulfamethoxazole may be the most effective treatment for adults because of its ability to penetrate cells. Total dose 10 mg/kg (based on trimethoprim component) in divided doses.
• Clarithromycin
• Ciprofloxacin

FOLLOW UP

PATIENT MONITORING:

• Frequent arterial blood gases during acute phase
• Repeat lumbar puncture at 24-48 hours and at the end of treatment

PREVENTION/AVOIDANCE:

• Avoid handling livestock during pregnancy
• Avoid contaminated silage
• Avoid contaminated sewage
• Avoid raw or contaminated milk products
• Avoid soft cheeses (Mexican and feta)
• Wash carefully all raw vegetables

POSSIBLE COMPLICATIONS:

• Premature delivery
• Amnionitis
• Meningitis
• Septicemia
• Pulmonary abscess
• Hepatic abscess
• Placental abscess
• Splenic abscess
• Lymph node abscess
• Endocarditis
• Peritonitis
• Abortion
• Stillbirth
• Neonatal death

EXPECTED COURSE AND PROGNOSIS:

High mortality if symptomatic

MISCELLANEOUS

ASSOCIATED CONDITIONS:

• Cirrhosis
• Lymphomas
• Solid tumors
• Immunodeficiencies
• Pregnancy

AGE-RELATED FACTORS:

Pediatric:
• Infected fetuses are usually stillborn or premature. More than half are infected with lethal listeriosis.
• 50% mortality in treated neonates
Geriatric: Greater morbidity and mortality
Others: N/A

PREGNANCY:

• Pregnant women are more susceptible to infection with Listeria monocytogenes; transmission to the fetus and neonates occurs with high mortality.
• Requires prompt and vigorous treatment to prevent transfer of disease to fetus (pregnant patient's symptoms may begin as a flu-like illness or be absent)

SYNONYMS:

• Listeria monocytogenes
• Listerial disease

ICD-9-CM:

027.0 Listeriosis

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Medical Diagnosis » L » Listeriosis II