engleski

Treatment of Legionnaires` disease: our experience and review of literature

Legionella is now recognized as an important cause of community-acquired pneumonia (CAP), accounting for 5-15% cases involving hospitalization, and it is among the top three to four organisms causing CAP. As the mortality rate from untreated Legionnaires' disease (LD) may range from 10-50% rapid diagnosis and early effective antibiotic treatment are essential. Till now, erythromycin has been traditionally recommended as drug of choice for the treatment of LD, but the newer macrolides (azithromycin, clarithromycin) have superior in vitro activity and greater intracellular and lung tissue penetration. Quinolones also have greater in vitro activity and better intracellular penetration. However, controlled clinical studies of treatment with new macrolides and quinolones are underway. Early treatment for any CAP in clinical practice is usually empirical because antibiotics are prescribed before laboratory confirmation of the diagnosis. The possibility of Legionella pneumonia should be considered in all patients with a severe CAP. Delay in the start of adequate therapy is associated with a poor outcome. Thus, all patients with pneumonia associated with respiratory failure, shock or severe underlying diseases should initially receive an agent active against Legionella. However, most cases of LD develop in immunocompetent patients as a mild infection and may be cured with any macrolides, fluoroquinolones or tetracyclines. The aim of this clinical, retrospective and non-comparative study is to evaluate our experience on efficacy of different antibiotics in the treatment of CAP caused by Legionella pneumophila. A total of 60 patients (53 male and 7 female) with confirmed LD were hospitalized in our hospital during the last four years. The LD was confirmed serologically (IFT or ELISA– test) and/or by specific Legionella antigen in urine (EIA). Out of 60 patients, 32 (53%) were treated with antibiotics (30 with beta-lactams and only 2 with azithromycin) before hospitalization. Two thirds of patients (40) were treated in hospital with two or more antibiotics. 25 or 42% patients were treated with ciprofloxacin, the most frequently in combination with beta-lactams. Patients receiving initially monotherapy with azithromycin (12/13), moxifloxacin (4/4), and doxycycline 2/3 were cured successfully. Our clinical experience shows that early antibiotic treatment with newer macrolides (azithromycin) and fluoroquinolones (moxifloxacin, ciprofloxacin) was clinically very effective and essential for outcome of illness.

Legionnaires` disease

nije evidentirano