What is the role of antibiotic therapy for the treatment of Legionnaires disease?

Updated: Aug 24, 2018
  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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In milder cases, patients can be treated in an outpatient setting with oral antibiotics. For patients who are hospitalized and treated with IV antibiotics, start oral antibiotics while in the hospital and observe the patients for continued response. Continue oral antibiotics on an outpatient basis for 14-21 days, depending on the severity of the presenting illness. Patients should receive close follow-up care to ensure complete resolution of their respiratory symptoms.

Patients should complete the full course of antibiotics, whether the treatment is initiated in the outpatient setting or in the hospital.

Historically, erythromycin, one of the original macrolide antibiotics, was used for L pneumophila infection. Currently, however, other antibiotics, including doxycycline, tigecycline, azithromycin, and a respiratory quinolone, are preferred, because they are more active against LD activity and have superior pharmacokinetic properties (eg, better bioavailability, better penetration into macrophages, longer half-life).

For severe disease, a fluoroquinolone is recommended. With doxycycline or fluoroquinolones, rifampin does not need to be added in severely ill patients.

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