Therapeutic targets
- Improvement of the symptomatology
- Elimination of pathogens
- Avoidance of complications
Therapy recommendations
- Symptomatic therapy (analgesics/pain relievers, antiemetics/anti-nausea and anti-nausea medications, if necessary).
- Procedure in a non-pregnant woman:
- Antibiotic therapy: first-line agents are amoxicillin or ampicillin (high-dose), combined with an aminoglycoside (e.g., gentamicin)
- In case of ampicillin allergy, cotrimoxazole can be used as an alternative.
- Therapy should be given for at least 3 weeks to avoid recurrence (recurrence of the disease). In rhombencephalitis (brain inflammation) or brain abscess even 6 weeks, in endocarditis (meningitis) 4-6 weeks.
- Caveat (Attention). Despite targeted therapy, there is a relatively high lethality (mortality) of manifest listeriosis (in recent years, about 21% of Listeria septicemia (-blood poisoning) and 13% of Listeria meningitis (-brain meningitis) fatal).
- Procedure for a pregnant woman who consumed a potentially contaminated food:
- Symptoms of listeriosis (fever above 38.1°C and symptoms not due to any other illness) are present:
- In parallel with the blood culture, antibiotic therapy with ampicillin (i.v. at least 6 g/d) must already be started and, if necessary, continued for at least 14 days. If necessary, this therapy should be supported with gentamicin (unless contraindicated, for example, because of pregnancy).
- In case of allergy to ampicillin or penicillin: combination trimethoprim-sulfamethoxazole.
- If the blood culture is negative after therapy has been started, an infectiologist should decide whether to discontinue or continue therapy. After birth, the placenta (placenta) should be examined for listeria.
- Mild gastrointestinal symptoms or flu-like symptoms are present, but patient is afebrile:
- Initially, it can be waited.
- To be sure, a blood culture can be taken. If positive → antibiotic therapy
- No symptoms typical of listeriosis present:
- Neither a test nor therapy is required.
- A new presentation should be made.
- Symptoms of listeriosis (fever above 38.1°C and symptoms not due to any other illness) are present:
- See also under “Further therapy”.
Further notes
- The prognosis of neuroinvasive listeriosis is not improved by combination therapy of ampicillin with aminoglycosides
