What is the treatment for Legionella pneumonia?

From the Guidelines

The treatment for Legionella pneumonia primarily involves antibiotics that can penetrate cells where the bacteria reside, with azithromycin or a fluoroquinolone being the preferred first-line treatments. According to the most recent and highest quality study 1, the preferred antimicrobial therapy for Legionella species is a fluoroquinolone or azithromycin. Some key points to consider in the treatment of Legionella pneumonia include:

• The use of azithromycin (500 mg daily for 5-10 days) or levofloxacin (750 mg daily for 7-14 days) as first-line treatments 1
• The potential use of combination therapy for severe cases, typically with a fluoroquinolone plus either rifampin or a macrolide 1
• The importance of hospitalization and intensive care for patients with respiratory failure or other severe symptoms 1
• The need for supportive care, including oxygen therapy, hydration, and respiratory support 1
• The importance of initiating treatment promptly, even before laboratory confirmation, if Legionella is suspected based on clinical presentation 1 The effectiveness of these antibiotics stems from their ability to concentrate within macrophages and other cells where Legionella bacteria multiply, as noted in the study 1. Early treatment significantly improves outcomes, as delayed therapy is associated with increased mortality 1. Most patients begin to improve within 3-5 days of starting appropriate antibiotics, though complete recovery may take several weeks.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to ... Legionella pneumophila... Azithromycin for Injection, USP is indicated for the treatment of patients with infections caused by susceptible strains of ... Legionella pneumophila...

The treatment for Legionella pneumonia is:

• Levofloxacin (PO) 2
• Azithromycin (IV) 3

From the Research

Treatment Options for Legionella Pneumonia

The treatment for Legionella pneumonia typically involves the use of antibiotics that are effective against Legionella species. The choice of antibiotic may depend on the severity of the illness, the patient's immune status, and other factors.

• First-line treatments:
  • Erythromycin is considered a first-line treatment for Legionella pneumonia, with an intravenous dosage of 1g every 6 hours as initial therapy 4.
  • Azithromycin and levofloxacin are also recommended as first-line therapies for Legionella infection 5, 6.
• Alternative treatments:
  • Clarithromycin, doxycycline, and ciprofloxacin are alternative treatments that can be used, especially in cases where the first-line treatments are not suitable 4, 7, 8.
  • Fluoroquinolones, such as ciprofloxacin, levofloxacin, and moxifloxacin, are also effective against Legionella species 7, 8.
• Severe cases:
  • In cases of severe Legionella pneumonia, a combined therapeutic approach may be warranted, with the addition of rifampicin to the usual dosage of erythromycin 4.
  • Quinolone/macrolide combinations, such as levofloxacin plus azithromycin, may be preferred in immunocompromised patients 8.
• Hospital-acquired cases:
  • In cases of hospital-acquired Legionella pneumonia, culturing of the hospital drinking water for Legionella is indicated, and treatment with azithromycin or levofloxacin may be considered 6.