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Listeria Meningitis — SCE Infectious Diseases MCQ

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EasyCNS InfectionListeria MeningitisSCE Infectious Diseases

A 45-year-old man presents with acute bacterial meningitis. CSF grows Listeria monocytogenes. He was initially treated with IV Ceftriaxone alone. Despite 48 hours of therapy, he remains febrile with worsening consciousness. What is the most likely reason for treatment failure?

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Correct answer: B — Cephalosporins have no activity against Listeria; he needs IV Amoxicillin (or Ampicillin)

Listeria monocytogenes is intrinsically resistant to all cephalosporins — this is a critical knowledge point for the ID SCE. The treatment of choice for Listeria meningitis is high-dose IV Amoxicillin (or Ampicillin) 2 g 4-hourly for at least 21 days, often with Gentamicin as synergistic therapy for the first 7 days. This is why empirical meningitis treatment in patients at risk of Listeria (age >50, immunosuppressed, pregnant) must include Amoxicillin in addition to Ceftriaxone.

Reference: NICE CG102 2010 – Bacterial meningitis; BSAC/BIA 2016 – Meningitis