Legionellosis medical therapy: Difference between revisions
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==Overview== | |||
==Medical Therapy== | ==Medical Therapy== | ||
Revision as of 16:53, 30 July 2015
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Legionellosis Microchapters |
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Treatment |
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Legionellosis medical therapy On the Web |
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Risk calculators and risk factors for Legionellosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Most cases of Legionella can be treated successfully with antibiotics. The most effective antibiotics are those that have excellent intracellular penetration where Legionella resides. The preferred regimen for non-immunocompromised patients with Legionellosis is either Azithromycin 500 mg PO qd for 3-5 days or Levofloxacin 500 mg PO qd for 7-10 days. Patients who are severely ill or immunocompromised may required intervenous regimens with the preferred regimens being Azithromycin 500 mg PO/IV q24h for 5-7 days or Levofloxacin 500 mg PO/IV q24h for 7-10 days OR 750 mg PO/IV q24h for 5-7 days. Early initiation of antibiotics is associated with lower mortality (<5%). Pontiac fever requires no specific antibiotic treatment, and the treatment is supportive.
Antimicrobial Regimen
- 1. Atypical pneumonia (Legionnaires' disease)[1]
- 1.1 Mild pneumonia inpatient or outpatient, non immunocompromised
- Preferred regimen (1): Azithromycin 500 mg PO qd for 3-5 days
- Preferred regimen (2): Levofloxacin 500 mg PO qd for 7-10 days
- Preferred regimen (3): Ciprofloxacin 500 mg PO bid for 7-10 days
- Preferred regimen (4): Moxifloxacin 400 mg PO qd for 7-10 days
- Preferred regimen (5): Clarithromycin 500 mg PO bid for 10-14 days
- Alternative regimen (1): Doxycycline 200 mg PO loading dose THEN 100 mg PO bid for 10-14 days
- Alternative regimen (2): Erythromycin 500 mg PO qid for 10-14 days
- Note: Patients with mild disease may be treated entirely with oral therapy
- 1.2 Moderate to severe pneumonia or immunocompromised
- Preferred regimen (1): Azithromycin 500 mg PO/IV q24h for 5-7 days
- Preferred regimen (2): Levofloxacin 500 mg PO/IV q24h for 7-10 days OR 750 mg PO/IV q24h for 5-7 days
- Alternative regimen (1): Ciprofloxacin 750 mg PO bid for 14 days
- Alternative regimen (2): Moxifloxacin 400 mg PO qd for 14 days
- Alternative regimen (3): Erythromycin 750-1000 mg IV q6h for 3-7 days THEN 500 mg PO qid for a total course of 21 days
- Alternative regimen (4): Clarithromycin 500 mg IV q12h for 3-7 days THEN 500 mg PO bid for a total course of 21 days
- Note: Severely ill patients parenteral therapy is advised until improvement is seen and oral absorption is sufficient.
- 2. Pontiac fever[2]
- Pontiac fever is febrile, self-limited form of Legionella infection which requires only symptomatic therapy, such as analgesics for headache. Antibiotics are not indicated.
- 3. Endocarditis[3]
- Preferred regimen (1): Levofloxacin 750 mg PO/IV qd for 7-10 days AND Rifampin 300 mg PO bid for 4-6 weeks
- Preferred regimen (2): Moxifloxacin 400 mg PO/IV qd for 7-10 days AND Rifampin 300 mg PO bid for 4-6 weeks
References
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.