Q: A 20-weeks pregnant patient is admitted to ICU with septic shock. Blood culture grew listeria. The patient is known to have had severe anaphylactic reactions to penicillin (PCN). What is the drug of choice in a pregnant penicillin-allergic patient with listeria bacteremia? (select one)
A) TMP-SMX
B) Clindamycin
C) Vancomycin
D) Ciprofloxacin
Answer: A
The first line of drugs in severe Listeriosis is ampicillin (or penicillin). Although few experts add gentamicin, it is not advisable due to its potential toxicity.
Trimethoprim/sulfamethoxazole (TMP-SMX), popularly known as Bactrim, is the drug of choice if a patient is PCN allergic. Unfortunately, Bactrim should be avoided in the first trimester and the last month of pregnancy. In the first trimester, Bactrim affects folic acid metabolism, and in the last month, it may cause kernicterus in the fetus. In those periods, meropenem can be used. Our patient is way out of those risk periods for Bactrim, so the answer is A.
Vancomycin has been proposed, but the failure rate is very high.
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#ob-gyn
References:
1. Committee Opinion No. 614: Management of pregnant women with presumptive exposure to Listeria monocytogenes. Obstet Gynecol 2014; 124:1241.
2. Charlier C, Perrodeau É, Leclercq A, et al. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective cohort study. Lancet Infect Dis 2017; 17:510.
3. Wang Z, Tao X, Liu S, Zhao Y, Yang X. An Update Review on Listeria Infection in Pregnancy. Infect Drug Resist. 2021 May 26;14:1967-1978. doi: 10.2147/IDR.S313675. PMID: 34079306; PMCID: PMC8165209.
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