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Chapter 2 : Treatment of Legionnaires’ Disease

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Treatment of Legionnaires’ Disease, Page 1 of 2

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Abstract:

Legionnaires’ disease (LD) treatment recommendations are supported by data obtained from in vitro and cellular studies, experimental studies with animal models, and observational studies, some of which come from prospective clinical studies of community-acquired pneumonia (CAP). There is some controversy about the use of new fluoroquinolones versus macrolides as the treatment of choice for LD. The least inflammation is found in the animal model with azithromycin, while the most is observed with erythromycin, with the quinolones being intermediate. Extrapulmonary manifestations of legionellosis, which are rare but sometimes observed in the immunocompromized host, may indicate significant therapeutic connotations. Mixed infections in legionellosis should be kept in mind concerning the inmunocompromized population since there are many reports of death when clinicians fail to identify and treat the dual component of infection. Some international guidelines recommend combined therapy for severe episodes but no consistent evidence supports this suggestion. For most patients monotherapy with a macrolide or a selected fluoroquinolone usually leads to a more cost-effective outcome. Possible toxicities of adding more than one antibiotic may be a concern, particularly in the intensive care unit setting. In vitro and in vivo evidence shows a highest potency of rifampin against , although the theoretical possibility of rapid induction of rifampin-resistant strains when it is administered alone precludes its use as sole therapy. The only variable that remained statistically significant on multivariate logistic regression analysis was the APACHE score (OR 1.86) at intensive care unit admission.

Citation: Roig J, Rello J. 2006. Treatment of Legionnaires’ Disease, p 8-14. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch02

Key Concept Ranking

Legionella pneumophila
0.82605535
Klebsiella pneumoniae
0.62181646
0.82605535
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FIGURE 1

Proposal for algorithmic approach to management of intubated patients with nonresolving legionellosis. From reference with permission of the British Society for Antimicrobial Therapy.

Citation: Roig J, Rello J. 2006. Treatment of Legionnaires’ Disease, p 8-14. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch02
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References

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Tables

Generic image for table
TABLE 1

Recommended therapy in Legionnaires’ disease

Citation: Roig J, Rello J. 2006. Treatment of Legionnaires’ Disease, p 8-14. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch02
Generic image for table
TABLE 2

Polymicrobial infection in legionellosis

Citation: Roig J, Rello J. 2006. Treatment of Legionnaires’ Disease, p 8-14. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch02

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