Antimicrobial Chemotherapy for Legionnaires’ Disease: Levofloxacin Versus Macrolides
Rosa Ma Blázquez Garrido, MD
Division of Infectious Diseases, Department of Microbiology, Hospital J. M. Morales Meseguer, Murcia, Spain
Erythromycin has been the most commonly used drug for the treatment of Legionnaires’ disease (LD). In recent years, however, some authors have proposed that therapy should consist of a fluoroquinolone or one of the newer macrolideazalide antimicrobials rather than erythromycin. Nevertheless, clinical experience with these agents is still limited and there are many questions and aspects that remain currently unknown. Macrolides and quinolones have been compared in vitro and in vivo. As a class, fluoroquinolone antimicrobials have the greatest activity against Legionella pneumophila in experimental models. Clinical comparison of macrolides and quinolones are based in retrospective studies with a small number of patients and not usually controlled for severity of disease, often concentrating on severe hospitalized cases. The general picture to emerge from such studies is that quinolones are more active than macrolides.
We have taken advantage of a large community outbreak of LD, which occurred in Murcia, Spain, to perform an observational, prospective study of treatment outcomes, comparing macrolide therapy with quinolone (levofloxacin) therapy. The study included 292 patients with confirmed LD. Results from our study indicate that levofloxacin is highly effective and safe in the treatment of LD and appears to be superior to clarithromycin therapy for severe disease with respect to development of complications, reduction in the number of bed days, and side effects. In conclusion, levofloxacin offers a safe and effective alternative for the treatment of LD.