title: Impact of rifampicin addition to clarithromycin in Legionella pneumophila pneumonia.
abstract: We evaluated the effectiveness and safety of rifampicin addition to clarithromycin in the treatment of Legionnaires' disease. An observational cohort study was conducted on patients assigned to a Legionnaires' disease outbreak. Of 32 patients with confirmed Legionella pneumonia, 11 received clarithromycin monotherapy and 21 received combination therapy of clarithromycin with rifampicin. Both groups had similar baseline characteristics and all patients were cured. Patients who received rifampicin had a 50% longer length of stay (P=0.035) and a trend towards higher bilirubin levels (P=0.053). Length of stay was directly correlated with the duration of rifampicin treatment (P=0.001). Combination therapy of clarithromycin and rifampicin had no additional benefit compared with clarithromycin monotherapy and could prolong the length of stay owing to possible negative drug interactions that could also affect other antibiotics.
authors.affiliation: Pharmacy Department, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain. sgrau@imas.imim.es
authors.forename: Santiago
authors.initials: S
authors.lastname: Grau
authors.forename: Javier Mateu-de
authors.initials: JM
authors.lastname: Antonio
authors.forename: Esther
authors.initials: E
authors.lastname: Ribes
authors.forename: Margarita
authors.initials: M
authors.lastname: Salvadó
authors.forename: Jose María
authors.initials: JM
authors.lastname: Garcés
authors.forename: Javier
authors.initials: J
authors.lastname: Garau
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004196:Disease Outbreaks; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000187:drug effects*; D007877:Legionnaires' Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D013030:Spain / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin; D001663:Bilirubin; D012293:Rifampin