Listeria rhombencephalitis — SCE Neurology MCQ
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Correct answer: D — Intravenous amoxicillin or ampicillin for 21 days; seek advice on co-trimoxazole for the first 7 days
NICE recommends intravenous amoxicillin or ampicillin for 21 days for meningitis caused by Listeria monocytogenes. Specialist advice should be sought on adding intravenous co-trimoxazole for the first 7 days. Third-generation cephalosporins such as ceftriaxone do not provide reliable Listeria cover. Gentamicin alone is inadequate and carries toxicity; oral step-down after 48 hours is not the recommended meningitis regimen. Aciclovir treats herpes viruses, not Listeria. Dose selection and monitoring still require renal function, allergy history and local microbiology input.
Reference: NICE NG240, bacterial meningitis and meningococcal disease: https://www.nice.org.uk/guidance/NG240/chapter/recommendations