Antimicrobial Chemotherapy for Legionnaires Disease: Time for a Change

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. 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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. 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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 ...