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Chapter 32 : Chemotherapy of Legionnaires' Disease with Macrolide or Quinolone Antimicrobial Agents

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Chemotherapy of Legionnaires' Disease with Macrolide or Quinolone Antimicrobial Agents, Page 1 of 2

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Abstract:

Effective antimicrobial chemotherapy of Legionnaires’ disease is driven primarily by the location of Legionella pneumophila inside cells, primarily alveolar macrophages. Determining optimal chemotherapy for Legionnaires’ disease by conducting truly informative clinical trials is generally of little use since the disease is uncommon and because the fatality rates in most community-acquired cases are relatively low. For effective chemotherapy to occur there must be colocalization of the bacterium and antimicrobial agents, and the antimicrobial agent must retain bioactivity against the bacterium. The β-lactam drugs are instead found in the cytosol, probably the main reason why they are ineffective in the treatment of Legionnaires’ disease. In cell culture model, erythromycin therapy results in survival rates that are the same for azithromycin or active quinolone antimicrobial agents. A number of obstacles have prevented such studies, including the great cost of diagnostic testing for Legionnaires’ disease, the relative rarity of the disease, and the usually low mortality in most community-acquired cases of the disease. Erythromycin is relatively poorly active against in cell culture and animal model studies. The superior drugs are azithromycin, levofloxacin, and some of the newer quinolone antimicrobial agents. There is little good evidence that addition of rifampin is beneficial for those receiving azithromycin, levofloxacin, or ciprofloxacin, and there is potential for undesirable toxicities or side effects from addition of rifampin.

Citation: Edelstein P. 2002. Chemotherapy of Legionnaires' Disease with Macrolide or Quinolone Antimicrobial Agents, p 183-188. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch32

Key Concept Ranking

Erythromycin
0.5763101
Azithromycin
0.54503727
Clarithromycin
0.49142703
0.5763101
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References

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1. Barker, J.,, H. Scaife,, and M. R. Brown.1995. Intraphagocytic growth induces an antibiotic-resistant phenotype of Legionella pneumophila. Antimicrob. Agents Chemother. 39:26842688.
2. Dournon, E.,, C. Mayaud,, M. Wolff,, B. SchJemmer,, D. Samuel,, J. P. Sollet,, and P. Levasseur-Rajagopalan. 1990. Comparison of the activity of three antibiotic regimens in severe Legionnaires' disease. J. Antimicrob. Chemother. 26(Suppl.B):129139.
3. Edelstein, P. H. 1995. Antimicrobial chemotherapy for legionnaires' disease: a review. Clin. Infect. Dis. 21:S265S276.
4. Edelstein, P. H. 1998. Antimicrobial chemotherapy for Legionnaires disease: time for a change. Ann. Intern. Med. 129:328330.
5. Edelstein, P. H., 1999. The guinea-pig model of Legionnaires' disease, p. 303314. In O. Zak, and M. A. Sande (ed.), Handbook of Animal Modeb of Infection. Academic Press, London, United Kingdom.
6. Edelstein, P. H.,, K. Calarco,, and V. K. Ya-sui. 1984. Antimicrobial therapy of experimentally induced Legionnaires' disease in guinea pigs. Am. Rev. Respir. Dis. 130:849856.
7. Edelstein, P. H.,, and M. A. Edelstein. 1999. In vitro activity of the ketolide HMR 3647 (RU 6647) for Legionella spp., its pharmacokinetics in guinea pigs, and use of the drug to treat guinea pigs with Legionella pneumophila pneumonia. Antimicrob. Agents Chemother. 43:9095.
8. Edelstein, P. H.,, and M. A. C. Edelstein. 1991. In vitro activity of azithromycin against clinical isolates of Legionella species. Antimicrob. Agents Chemother. 35:180181.
9. Edelstein, P. H ., , M. A. C. Edelstein,, K. H. Lehr,, and J. Ren. 1996. In-vitro activity of levofloxacin against clinical isolates of Legionella spp, its pharmacokinetics in guinea pigs, and use in experimental Legionella pneumophila pneumonia.J. Antimicrob. Chemother. 37:117126.
10. Edelstein, P. H.,, M. A. C. Edelstein,, J. J. Ren,, R. Polzer,, and R. P. Gladue. 1996. Activity of trovafloxacin (cp-99,219) against Legionella isolates: in-vitro activity, intracellular accumulation and killing in macrophages, and pharmacokinetics and treatment of guinea-pig with L. pneumophila pneumonia. Antimicrob. Agents Chemother. 40:314319.
11. Edelstein, P. H.,, M. A. C. Edelstein,, J. Weidenfeld,, and M. B. Dorr. 1990. In vitro activity of sparfloxacin (CI-978; AT-4140) for clinical Legionella isolates, pharmacokinetics in guinea pigs, and use to treat guinea pigs with L. pneumophila pneumonia. Antimicrob. Agents Chemother. 34:21222127.
12. Fraser, D. W.,, T. R. Tsai,, W. Orenstein,, W. E. Parkin,, H. J. Beecham,, R. G. Sharrar,, J. Harris,, G. F. Mallison,, S. M. Martin,, J. E. McDade,, C. C. Shepard,, and P. S. Brachman. 1977. Legionnaires' disease: description of an epidemic of pneumonia. N. Engl. J. Med. 297: 11891197.
13. Kirby, B. D.,, K. M. Snyder,, R. D. Meyer,, and S. M. Finegold. 1980. Legionnaires' disease: report of sixty-five nosocomially acquired cases and review of the literature. Medicine (Baltimore) 59:188205.
14. Kunishima, H.,, H. Takemura,, H. Yamamoto,, K. Kanemitsu,, and J. Shimada. 2000. Evaluation of the activity of antimicrobial agents against Legionella pneumophila multiplying in human monocytic cell line, THP-1, and an alveolar cell line, A549. J. Infect. Chemother. 6:206210.
15. Sturgill-Koszycki, S.,, and M. S. Swanson. 2000. Legionella pneumophila replication vacuoles mature into acidic, endocytic organelles. J. Exp. Med. 192:12611272.
16. Swanson, M. S.,, and B. K. Hammer. 2000. Legionella pneumophila pathogenesis: a fateful journey from amoebae to macrophages. Annu. Rev. Microbiol. 54:567613.
17. Tulkens, P. M. 1991. Intracellular distribution and activity of antibiotics. Eur. J. Clin. Microbiol. Infect. Dis. 10:100106.

Tables

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TABLE 1

Preferred therapy for Legionnaires' disease

Citation: Edelstein P. 2002. Chemotherapy of Legionnaires' Disease with Macrolide or Quinolone Antimicrobial Agents, p 183-188. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch32

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