Inappropriate Antimicrobial Regimen Leading to Recurrent Listeria monocytogenes Meningitis: A PK/PD-Based Case...

To elucidate the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of antimicrobial agents used in the treatment of Listeria monocytogenes (L. monocytogenes) meningitis and to provide evidence-based guidance for individualized dosing regimens in clinical practice.

A combined approach involving retrospective case analysis and a literature review was employed. The PK/PD characteristics of various antimicrobial agents applicable to the treatment of L. monocytogenes meningitis were comprehensively evaluated, and the rationality of different dosing regimens was assessed.

Case analysis revealed that inappropriate antimicrobial selection and insufficient dosing contributed to early disease relapse during treatment. Furthermore, a review of 43 published case reports has demonstrated that ampicillin in combination with gentamicin remains the first-line therapy for L. monocytogenes meningitis. However, when penicillin-based agents are contraindicated, alternative antimicrobial agents should be selected according to cerebrospinal fluid (CSF) penetration and PK/PD characteristics, with optimized and standardized dosing regimens established accordingly.

Selection of antimicrobial therapy for L. monocytogenes meningitis should be guided by pharmacokinetic principles. Individualized precision therapy based on lesion-site PK/PD characteristics is essential to improve treatment success and patient prognosis.