Legionellosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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Pharmacologic medical therapy is indicated in Legionnaires' disease. The preferred regimens for both mild and moderate-to-severe pneumonia include either azithromycin or a fluoroquinolone. Patients who develop legionellosis-related complications may require other or additional pharmacologic agents. Pontiac fever is self-limited and may be treated with symptomatic therapy only.

## Medical Therapy

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### Antimicrobial Regimen

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* 1\. Atypical pneumonia (Legionnaires' disease)[1]

* 1.1 Mild pneumonia, non-immunocompromised (inpatient or outpatient)

* 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

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1. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
3. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

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