Listeria monocytogenes: Synergistic Effects of Ampicillin and Gentamicin

Listeria monocytogenes infections are most common in newborn infants and persons with impaired defense mechanisms. There are reports of successful treatment with ampicillin alone: however, there is uncertainty as to what regimen constitutes the most effective therapy. The purpose of this study was to illustrate the in-vitro synergism between ampicillin and gentamicin against L. monocytogenes. Seven strains of L. monocytogenes isolated from bloods or cerebrospinal fluids of infants and three control strains obtained from the Center for Disease Control were tested. Minimal inhibitory concentrations of ampicillin and gentamicin were determined in Todd-Hewitt broth with an inoculum of 10(5) organisms/ml. Killing curves were determined for ampicillin 6 microgram/ml, gentamicin, 0.5 microgram/ml, and the combination of ampicillin, 6 microgram/ml, plus gentamicin, 0.5 microgram/ml. Incubation of approximately 10(7) organisms/ml with these concentrations of ampicillin and gentamicin caused no significant reduction in the viable bacterial population in 24 hours. The combination, on the other hand, was bactericidal in all seven strains isolated from patients and one control strain. The authors believe the ultimate test of the superiority of this combination to ampicillin alone must come from clinical studies. However, the synergistic and bactericidal effects of ampicillin with gentamicin may be very desirable in treatment of newborns and patients with underlying disease.