Legionella infection

Patients admitted to hospital should receive the longer duration of 14 days for levofloxacin therapy. Giving intravenous therapy early ensures drug absorption during the acute phase of the illness.

There is less evidence of efficacy for ciprofloxacin and moxifloxacin, so they are generally reserved for use in milder disease.

Macrolides can be used as first-line treatment instead of fluoroquinolones.

The empirical treatment recommendations from the Infectious Diseases Society of America/American Thoracic Society guidelines for community-acquired pneumonia may be applied to patients with mild/moderate Legionella.[54]Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812437 http://www.ncbi.nlm.nih.gov/pubmed/31573350?tool=bestpractice.com ​ Consulting local guidance is recommended as antibiotic regimens may vary in different locations.

Systemic fluoroquinolone antibiotics may cause serious, disabling, and potentially long-lasting or irreversible adverse events. These include, but is not limited to: tendinopathy/tendon rupture; peripheral neuropathy; arthropathy/arthralgia; aortic aneurysm and dissection; heart valve regurgitation; dysglycaemia; and central nervous system (CNS) effects including seizures, depression, psychosis, and suicidal thoughts and behaviour.[72]Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804. https://www.mdpi.com/1999-4923/15/3/804 http://www.ncbi.nlm.nih.gov/pubmed/36986665?tool=bestpractice.com ​ Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability). Consult your local guidelines and drug formulary for more information on suitability, contraindications, and precautions.

Tetracyclines may be used as an alternative treatment option where the patient has a known allergy to first-line options, or primary treatment agents are unavailable.

Patients with persistent fever, productive cough, hypoxia, hypercapnia, worsening pulmonary function, and systemic signs of sepsis with hypotension may benefit from a combination of fluoroquinolone and macrolide therapy.[73]Dournon E, Mayaud CH, Wolff M, et al. Comparison of the activity of three antibiotic regimens in severe LD. J. Antimicrob Chemother. 1990 Oct;26(suppl B):129-39. http://www.ncbi.nlm.nih.gov/pubmed/2258340?tool=bestpractice.com However, caution is recommended as this combination has significant potential toxicity, such as prolongation of the QT interval and torsades de pointes arrhythmia.[74]Roig J, Rello J. Legionnaires' disease: a rational approach to therapy. J Antimicrob Chemother. 2003 May;51(5):1119-29. http://jac.oxfordjournals.org/cgi/content/full/51/5/1119 http://www.ncbi.nlm.nih.gov/pubmed/12668578?tool=bestpractice.com

The empirical treatment recommendations from the Infectious Diseases Society of America/American Thoracic Society guidelines for community-acquired pneumonia may be applied to patients with severe Legionella.[54]Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812437 http://www.ncbi.nlm.nih.gov/pubmed/31573350?tool=bestpractice.com ​ Consulting local guidance is recommended as antibiotic regimens may vary in different locations.

Systemic fluoroquinolone antibiotics may cause serious, disabling, and potentially long-lasting or irreversible adverse events. These include, but is not limited to: tendinopathy/tendon rupture; peripheral neuropathy; arthropathy/arthralgia; aortic aneurysm and dissection; heart valve regurgitation; dysglycaemia; and CNS effects including seizures, depression, psychosis, and suicidal thoughts and behaviour.[72]Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804. https://www.mdpi.com/1999-4923/15/3/804 http://www.ncbi.nlm.nih.gov/pubmed/36986665?tool=bestpractice.com ​ Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability). Consult your local guidelines and drug formulary for more information on suitability, contraindications, and precautions.