What is the diagnosis and treatment for Listeria (Listeria monocytogenes) myositis?

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From the Guidelines

Listeria myositis should be treated with ampicillin plus gentamicin as the first-line therapy, as recommended by the Infectious Diseases Society of America 1. The treatment of Listeria myositis involves the administration of intravenous antibiotics, with the goal of reducing morbidity and mortality, and improving quality of life.

  • The first-line therapy for Listeria myositis is ampicillin (2g IV every 4 hours) plus gentamicin, which is recommended by the Infectious Diseases Society of America 1.
  • For patients allergic to penicillin, trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred alternative, as it is an effective treatment for Listeria monocytogenes infections 1.
  • The treatment duration for Listeria myositis typically ranges from 2-3 weeks for uncomplicated cases and 3-6 weeks for severe or complicated infections.
  • Patients with Listeria myositis often present with fever, muscle pain, and weakness, particularly affecting the trunk and proximal limbs, and may require supportive care, including pain management and physical therapy, to restore muscle function.
  • Diagnosis of Listeria myositis requires muscle biopsy with culture and blood cultures, and it is essential to initiate treatment promptly to reduce the risk of complications and improve outcomes.
  • Listeria monocytogenes is an intracellular pathogen that can evade immune responses, which explains why antibiotics that achieve high intracellular concentrations, such as ampicillin and TMP-SMX, are most effective in treating Listeria myositis 1.

From the FDA Drug Label

Ampicillin for Injection, USP is indicated in the treatment of infections caused by susceptible strains of the designated organisms in the following conditions: ... Bacterial Meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria (Listeria monocytogenes, N. meningitidis).

The FDA drug label does not answer the question about listeria myositis.

From the Research

Listeria Myositis

  • Listeria myositis is not explicitly mentioned in the provided studies, however, the studies discuss various aspects of Listeria infections, including treatment options and manifestations.
  • The studies suggest that Listeria infections can manifest in different forms, including bacteraemia, meningitis, and infective endocarditis 2, 3, 4, 5.
  • Treatment options for Listeria infections include ampicillin, penicillin, gentamicin, and co-trimoxazole, with combination therapy often recommended for invasive infections 2, 3, 4, 5, 6.
  • The choice of antibiotic therapy may depend on the specific manifestation of the infection, as well as the patient's underlying health status and potential allergies 2, 3, 5.
  • Some studies suggest that gentamicin combination treatment may be associated with lower mortality rates in patients with invasive listeriosis 4.
  • It is essential to note that Listeria infections can have severe consequences, particularly in high-risk individuals such as pregnant women, the elderly, and those with compromised immune systems 2, 3, 5.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Treatment of listeriosis.

The Annals of pharmacotherapy, 2000

Research

Antimicrobial chemotherapy of human infection due to Listeria monocytogenes.

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 1995

Research

Listeria monocytogenes infections: presentation, diagnosis and treatment.

British journal of hospital medicine (London, England : 2005), 2021

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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