If this cannot be tolerated, azithromycin, clarithromycin, levofloxacin, ciprofloxacin and doxycycline can all be used. (1) In some cases, tetracycline, ciprofloxacin, and other fluoroquinolone and macrolide drugs may be considered. (2)
Any course of treatment should be for 10-21 days and is usually intravenous, at least at first. (3)
In critically ill patients macrolides and fluoroquinolones should be used as first-line therapy.
Severe infections may require the addition of rifampicin
Support must be given in the event of any system failure - ventilation in respiratory failure, dialysis in renal failure
References:
File TM Jr, Garau J, Blasi F, et al. Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia. Chest. 2004 May;125(5):1888-901.
Mills GD. et al. Effectiveness of beta lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ. 2005 Feb
Amsden GW. Treatment of Legionnaires' disease. Drugs. 2005;65(5):605-14.
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