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Treatment of Legionnaire's disease

Authoring team

  • Erythromycin is the treatment of choice
  • 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:

  1. 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.
  2. 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
  3. Amsden GW. Treatment of Legionnaires' disease. Drugs. 2005;65(5):605-14.

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