Antimicrobial Chemotherapy for Legionnaires Disease: Time for a Change
Authors: Paul H. Edelstein
Journal: Annals of Internal Medicine (1998)

Editorials15 August 1998Antimicrobial Chemotherapy for Legionnaires Disease: Time for a ChangePaul H. Edelstein, MDPaul H. Edelstein, MDUniversity of Pennsylvania Medical Center; Philadelphia, PA 19104-4283Note: Dr. Edelstein has received funding for research and related academic purposes from manufacturers of both macrolide and quinolone antibiotics.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-4-199808150-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Erythromycin became the de facto standard of treatment for Legionnaires disease soon after the first recognized epidemic of this disease occurred 22 years ago [1, 2]. However, it is now time for a change in therapy because of increasing evidence of the superiority of newer antimicrobial agents. The conclusion that erythromycin is the drug of choice for Legionnaires disease was based on unavoidably imperfect retrospective analysis of treatment outcomes from the epidemic, which showed the lowest overall fatality rates with either erythromycin or tetracycline therapy. No prospective comparative studies with adequate statistical power of the treatment of Legionnaires disease have ...References1. Fraser DW, Tsai TR, Orenstein W, Parkin WE, Beecham HJ, Sharrar RG, et al. Legionnaires' disease: description of an epidemic of pneumonia. N Engl J Med. 1977; 297:1189-97. Google Scholar2. Meyer RD, Finegold SM. Legionnaires' disease. Annu Rev Med. 1980; 31:219-32. Google Scholar3. Edelstein PH. Antimicrobial chemotherapy for legionnaires' disease: a review. Clin Infect Dis. 1995; 21:S265-76. Google Scholar4. Kirby BD, Snyder KM, Meyer RD, Finegold SM. Legionnaires' disease: report of sixty-five nosocomially acquired cases and review of the literature. Medicine (Baltimore). 1980; 59:188-205. Google Scholar5. Heath CH, Grove DI, Looke DF. Delay in appropriate therapy of Legionella pneumonia associated with increased mortality. Eur J Clin Microbiol Infect Dis. 1996; 15:286-90. Google Scholar6. Marston BJ, Lipman HB, Breiman RF. Surveillance for Legionnaires' disease. Risk factors for morbidity and mortality. Arch Intern Med. 1994; 154:2417-22. Google Scholar7. O'Mahony MC, Stanwell-Smith RE, Tillett HE, Harper D, Hutchison JG, Farrell ID, et al. The Stafford outbreak of Legionnaires' disease. Epidemiol Infect. 1990; 104:361-80. Google Scholar8. Falco V, Fernandez de Sevilla T, Alegre J, Ferrer A, Martinez Vazquez JM. Legionella pneumophila. A cause of severe community-acquired pneumonia. Chest. 1991; 100:1007-11. Google Scholar9. Roig J, Aguilar X, Ruiz J, Domingo C, Mesalles E, Manterola J, et al. Comparative study of Legionella pneumophila and other nosocomial-acquired pneumonias. Chest. 1991; 99:344-50. Google Scholar10. Dournon E, Mayaud C, Wolff M, Schlemmer B, Samuel D, Sollet JP, et al. Comparison of the activity of three antibiotic regimens in severe Legionnaires' disease. J Antimicrob Chemother. 1990; 26(Suppl B):129-39. Google Scholar11. Gump DW, Frank RO, Winn WC Jr, Foster RS Jr, Broome CV, Cherry WB. Legionnaires' disease in patients with associated serious disease. Ann Intern Med. 1979; 90:538-42. Google Scholar12. Dowling JN, Kroboth FJ, Karpf M, Yee RB, Pasculle AW. Pneumonia and multiple lung abscesses caused by dual infection with Legionella micdadei and Legionella pneumophila. Am Rev Respir Dis. 1983; 127:121-5. Google Scholar13. Koch CA, Robyn JA, Coccia MR. Systemic lupus erythematosus: a risk factor for pneumonia caused by Legionella micdadei? Arch Intern Med. 1997; 157:2670-1. Google Scholar14. Anastasio GD, Little JM Jr, Robinson MD, Pettice YL, Leitch BB, Norton HJ. Impact of compliance and side effects on the clinical outcome of patients treated with oral erythromycin. Pharmacotherapy. 1994; 14:229-34. Google Scholar15. Magat AH, Alger LS, Nagey DA, Hatch V, Lovchik JC. Double-blind randomized study comparing amoxicillin and erythromycin for the treatment of Chlamydia trachomatis in pregnancy. Obstet Gynecol. 1993; 81:745-9. Google Scholar16. Classen DC, Pestotnik SL, Lloyd JF, Burke JP. Adverse effects of intravenous erythromycin in hospital patients: attributable costs and excess length of stay [Abstract]. In: Program and Abstracts of the 1996 International Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Society for Microbiology; 1996:N19. Google Scholar17. Edelstein PH, Edelstein MA, Ren J, Polzer R, Gladue RP. Activity of trovafloxacin (CP-99,219) against Legionella isolates: in vitro activity, intracellular accumulation and killing in macrophages, and pharmacokinetics and treatment of guinea pigs with L. pneumophila pneumonia. Antimicrob Agents Chemother. 1996; 40:314-9. Google Scholar18. File TM Jr, Segreti J, Dunbar L, Player R, Kohler R, Williams RR, et al. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother. 1997; 41:1965-72. Google Scholar19. Trovan Product Insert. New York: Pfizer Pharmaceuticals; December 1997. Google Scholar20. Fishman N, Morgan A, Green S. Guidelines for antibiotic therapy at the Hospital of the University of Pennsylvania, 1998 edition. 18 February 1998. Available at http://www.med.upenn.edu/bugdrug/. Accessed 2 March 1998. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Pennsylvania Medical Center; Philadelphia, PA 19104-4283Note: Dr. Edelstein has received funding for research and related academic purposes from manufacturers of both macrolide and quinolone antibiotics.Acknowledgment: The author thanks Richard D. Meyer for reviewing the manuscript and suggesting changes.Corresponding Author: Paul H. Edelstein, MD, Clinical Microbiology Laboratory, 4 Gates, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104-4283; e-mail, [email protected] PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTherapy for Legionnaires Disease James R. Johnson Therapy for Legionnaires Disease Paul H. Edelstein Metrics Cited ByTrends in the incidence and mortality of legionellosis in Japan: a nationwide observational study, 1999–2017Susceptibility of Legionella pneumophila to antimicrobial agents and the presence of the efflux pump LpeABManagement of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017Levofloxacin versus azithromycin for treating legionella pneumonia: a propensity score analysisLegionnaires' diseaseThe Association of Antibiotic Treatment Regimen and Hospital Mortality in Patients Hospitalized With Legionella PneumoniaQuinolonesChemotherapy of Legionnaires' Disease with Macrolide or Quinolone Antimicrobial AgentsTreatment of Legionnaires' DiseaseLegionnaires' DiseaseSwedish guidelines on the management of community-acquired pneumonia in immunocompetent adults—Swedish Society of Infectious Diseases 2012LégionellosesReview of the Quinolone FamilyA Case of Repeated Upper Gastrointestinal Bleeding Secondary to Legionella pneumoniaResearch advances of Legionella and Legionnaires' diseaseLegionellaQuinolonesMutational paths towards increased fluoroquinolone resistance in Legionella pneumophilaClinical features and outcomes of Legionnaires' disease in solid organ transplant recipientsRespiratory tract infections and pneumoniaNosocomial legionellosis: prevention and managementLEGIONNAIRES' DISEASE, PONTIAC FEVER, AND RELATED ILLNESSESÉpidémie de légionellose dans le Pas-de-Calais (2003-2004) : analyse descriptive et facteurs prédictifs d'une évolution défavorableLegionella spp. and Legionnaires' diseaseWhat Is New in Legionella Management?Outbreak of Legionnaires' disease in immunosuppressed patients at a cancer centre: usefulness of universal urine antigen testing and early levofloxacin therapyLegionnaires' DiseaseIntravenous Ciprofloxacin versus Erythromycin in the Treatment of Legionella PneumoniaCurrent clinical management of Legionnaires' disease13 – Antibiotic therapy of community-acquired pneumonia (CAP) caused by atypical agentsLegionella Species and Legionnaires' DiseaseSevere Japanese Spotted Fever Successfully Treated with FluoroquinoloneIn vitro activity of pazufloxacin, tosufloxacin and other quinolones against Legionella speciesFluoroquinolones vs Macrolides in the Treatment of Legionnaires DiseaseLegionelosisHost-Pathogen Relationships among Escherichia coli Isolates Recovered from Men with Febrile Urinary Tract InfectionAntimicrobial Chemotherapy for Legionnaires Disease: Levofloxacin versus MacrolidesClinical Outcomes for Hospitalized Patients with Legionella Pneumonia in the Antigenuria Era: The Influence of Levofloxacin TherapyEfficacy of pazufloxacin mesilate in Legionnaires' disease: a case report and in vitro study of the isolateSwedish guidelines for the management of community-acquired pneumonia in immunocompetent adultsLegionella Pneumonia Associated with Adult Respiratory Distress Syndrome Caused by Legionella Pneumophila Serogroup 3Empiric treatment of ambulatory community-acquired pneumonia: always include treatment for atypical agentsIn Vitro Activity of Thiamphenicol, Erythromycin and Fluoroquinolones against Legionella pneumophilaThe newer fluoroquinolonesLégionellosesUpdate of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent AdultsTreating legionnaires' diseaseLegionnaires' DiseaseBeatmungsassoziierte PneumonienLegionella and Legionnaires' Disease: 25 Years of InvestigationIn vitro activity of levofloxacin against contemporary clinical isolates of Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae from North America and EuropeNeumonía comunitaria grave por Legionella pneumophilaComplicated Nosocomial Pneumonia due to Legionella pneumophila in an Immunocompromised ChildINFECTIONS IN RECIPIENTS OF KIDNEY TRANSPLANTSPersistently Positive Culture Results in a Patient with Community-Acquired Pneumonia Due to Legionella pneumophilaApproach to Severe Community Acquired LegionellosisApproach to Severe LegionellosisSevere LegionellosisThe Role of Newer Quinolones in the Management of Infections in Patients with Hematologic MalignanciesSensibilidad in vitro actual de los patógenos respiratorios bacterianos más frecuentes: implicaciones clínicasPractice Guidelines for the Management of Community-Acquired Pneumonia in AdultsUpdate on LegionellaFLUOROQUINOLONESIs a 5 day course of azithromycin enough for infections caused by Legionella pneumophila?New Uses for New and Old Quinolones and the Challenge of ResistanceThe QuinolonesUse of the Quinolones in Immunocompromised PatientsTHERAPY FOR VENTILATOR-ASSOCIATED PNEUMONIAAnálisis comparativo de las normativas para el tratamiento de las neumonías adquiridas en la comunidadTherapy for Legionnaires DiseaseJames R. Johnson, MDDefense mechanisms against infectionsDiagnostic et traitement des légionellosesUpdate of Legionella infectionsLegionellaTrovafloxacin Susceptibility of Aerobic Clinical Bacterial Isolates from SwedenLegionellosis 15 August 1998Volume 129, Issue 4Page: 328-330KeywordsAntimicrobialsClinical trialsDrug therapyDrugsErythromycinFood and Drug AdministrationLegionellosisOutpatientsPneumoniaResearch laboratories Issue Published: 15 August 1998 CopyrightCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...