eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Listeria Infection: Treatment & Medication

Author: Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Coauthor(s): Ann L Anderson-Berry, MD, Assistant Professor of Pediatrics, Joint Division of Newborn Medicine, Creighton University, University of Nebraska Medical Center
Contributor Information and Disclosures

Updated: May 29, 2009

Treatment

Medical Care

  • Care of a newborn with Listeria infection includes antibiotics as well as careful monitoring of the patient's temperature, respiratory system, fluid and electrolyte balance, nutrition, and cardiovascular support.
  • Critically ill newborns are best treated in a neonatal ICU.

Consultations

  • Consultations with neonatologists or pediatric infectious disease specialists may be useful when caring for newborns.

Medication

Antibiotics

These agents are used for suspected bacterial infections. Ampicillin in combination with an aminoglycoside such as gentamicin is the therapy of choice. Listeria is not susceptible to cephalosporins of any generation. Therefore, cephalosporins should not be used to treat Listeria infections.


Ampicillin (Marcillin, Omnipen, Polycillin, Principen)

DOC. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity.
Usual neonatal dosage for treatment of septicemia or meningitis depends on gestational and postnatal age. Higher doses are used with severe infections or meningitis.

Adult

1-3 g IV q3-4h; not to exceed 12 g/d

Pediatric

Ampicillin dosing based on 25-100 mg/kg/dose slow IV push (higher doses typically used for meningitis)
Gestational age <29 weeks
Postnatal age of 0-28 days: Dose frequency = q12h
Postnatal age of >28 days: Dose frequency = q8h
Gestational age 30-36 weeks
Postnatal age of 0-14 days: Dose frequency = q12h
Postnatal age of >14 days: Dose frequency = q8h
Gestational age 37-44 weeks
Postnatal age of 0-7 days: Dose frequency = q12h
Postnatal age of > 7 days: Dose frequency = q8h
Gestational age >44 weeks
All postnatal ages: Dose frequency = q6h

Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Renal, hepatic, and hematologic systems should be evaluated periodically in older children and adults on ampicillin; very large doses may result in CNS excitation or seizure activity


Gentamicin (Garamycin, Gentacidin)

Useful in combination with ampicillin against listeria.

Adult

3-5 mg/kg/d IV/IM q8h

Pediatric

Usual neonatal maintenance dosage for treatment of septicemia or meningitis depends on gestational and postnatal age
Gentamicin neonatal dosing scheme: Loading dose of 4 mg/kg can be given
Maintenance dose: 2.5-3 mg/kg/dose IV infused over 30 min
Gestational age <29 weeks
Postnatal age of 0-28 days: Dose frequency = q24h
Postnatal age of >28 days: Dose frequency = q24h (consider using 3 mg/kg/dose)
Gestational age 30-36 weeks
Postnatal age of 0-14 days: Dose frequency = q24h (consider using 3 mg/kg/dose)
Postnatal age of >14 days: Dose frequency = q24h
Gestational age >37 weeks
Postnatal age of 0-7 days: Dose frequency = q12h
Postnatal age of > 7 days: Dose frequency = q8h

Coadministration with other aminoglycosides, cephalosporins, penicillins, and amphotericin B may increase nephrotoxicity; aminoglycosides enhance effects of neuromuscular blocking agents thus prolonged respiratory depression may occur
Coadministration with loop diuretics may increase auditory toxicity of aminoglycosides; possible irreversible hearing loss of varying degrees may occur (monitor regularly)

Documented hypersensitivity; non–dialysis-dependent renal insufficiency

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Narrow therapeutic index (not intended for long-term therapy); caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission; adjust dose in renal impairment


Sulfamethoxazole and Trimethoprim (Bactrim, Cotrim, Septra)

Second-line DOC for non-neonatal penicillin-allergic patients. Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid.

Adult

15-20 mg/kg/d (based on trimethoprim component) PO/IV divided qid

Pediatric

<2 months: Do not administer
>2 months: 8-12 mg/kg/d (based on trimethoprim component) IV divided qid

May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine

Documented hypersensitivity; megaloblastic anemia caused by folate deficiency; age <2 months

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not use in pregnancy near term (risk of kernicterus); discontinue at first appearance of rash or sign of adverse reaction; frequently obtain CBC counts; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholism, elderly persons, patients receiving anticonvulsant therapy, or patients with malabsorption syndrome); hemolysis may occur in G-6-PD deficiency; patients with AIDS may not tolerate or respond to trimethoprim-sulfamethoxazole; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation


Penicillin G (Pfizerpen)

Can be used as an alternative to ampicillin. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity.

Adult

15-20 million U/d IV divided q4-6h

Pediatric

250,000-400,000 U/kg/d IV divided q4-6h

Probenecid can increase effects of penicillin; coadministration of tetracyclines can decrease effects of penicillin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function

More on Listeria Infection

Overview: Listeria Infection
Differential Diagnoses & Workup: Listeria Infection
Treatment & Medication: Listeria Infection
Follow-up: Listeria Infection
Multimedia: Listeria Infection
References
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References

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Further Reading

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Keywords

listeria infection, listeriosis, neonatal listeriosis, meningitis, Listeria monocytogenes, L monocytogenes, Listeria, chorioamnionitis, premature labor, spontaneous abortion, early onset neonatal listeriosis, late-onset neonatal listeriosis, granulomatosis infantisepticum, hydrocephalus, mental retardation, neonatal sepsis, Listeria meningitis, respiratory distress, treatment, diagnosis

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Contributor Information and Disclosures

Author

Terence Zach, MD, Department Vice-Chair, Professor, Department of Pediatrics, Section of Newborn Medicine, Creighton University
Terence Zach, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Ann L Anderson-Berry, MD, Assistant Professor of Pediatrics, Joint Division of Newborn Medicine, Creighton University, University of Nebraska Medical Center
Ann L Anderson-Berry, MD is a member of the following medical societies: American Academy of Pediatrics and Nebraska Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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