title: Antimicrobial chemotherapy for Legionnaires disease: levofloxacin versus macrolides.
abstract: BACKGROUND
  The community outbreak of legionnaires disease that occurred in Murcia, Spain, in July 2001--to our knowledge, the largest such outbreak ever reported--afforded an unusual opportunity to compare the clinical response of patients with Legionella pneumonia treated with levofloxacin with that of patients treated with macrolides and to determine the role of rifampicin combined with levofloxacin in treating severe legionellosis.
  
  
  METHODS
  An observational, prospective, nonrandomized study was conducted involving 292 patients seen at our hospital (Hospital "J. M. Morales Meseguer"; Murcia, Spain) who received a diagnosis of Legionella pneumonia during the Murcia outbreak. To compare both antibiotic regimens (macrolides vs. levofloxacin), patients were stratified by the severity of pneumonia. Duration of fever, clinical outcome, complications, side effects, and length of hospital stay were recorded. To assess the potential effects of adjuvant therapy with rifampicin, 45 case patients treated with levofloxacin plus rifampicin were evaluated and compared with 45 control pairs who were treated with levofloxacin alone.
  
  
  RESULTS
  With the exception of 2 patients who died, all patients were cured. There were no significant differences between treatment groups in clinical outcome for patients with mild-to-moderate pneumonia. Nevertheless, in patients with severe pneumonia, levofloxacin exerted superior activity; it was associated with fewer complications (3.4% of patients receiving levofloxacin experienced complications, compared with 27.2% of patients receiving macrolides; P=.02) and shorter mean hospital stays (5.5 vs. 11.3 days; P=.04). Addition of rifampicin to the treatment regimen for patients receiveing levofloxacin for severe pneumonia provides no additional benefit.
  
  
  CONCLUSIONS
  Our findings strongly suggest that monotherapy with levofloxacin is a safe and effective treatment for legionnaires disease, including in patients with severe disease. In these patients, levofloxacin appears to be more effective than clarithromycin.
authors.affiliation: Section of Infectious Diseases, Department of Microbiology, Hospital J. M. Morales Meseguer, Murcia, Spain. rblazquezg@yahoo.es
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Blázquez Garrido
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Espinosa Parra
authors.forename: Loreto
authors.initials: L
authors.lastname: Alemany Francés
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Ramos Guevara
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Sánchez-Nieto
authors.forename: Manuel
authors.initials: M
authors.lastname: Segovia Hernández
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Serrano Martínez
authors.forename: Faustino Herrero
authors.initials: FH
authors.lastname: Huerta
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D004196:Disease Outbreaks; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007877:Legionnaires' Disease / Q000188:drug therapy*; D064704:Levofloxacin; D018942:Macrolides / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D012293:Rifampin
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D064704:Levofloxacin; D015242:Ofloxacin; D012293:Rifampin