title: Role of rifampin-based combination therapy for severe community-acquired Legionella pneumophila pneumonia.
abstract: OBJECTIVE
  To review the literature concerning the role of rifampin in the combination treatment of Legionella pneumophila pneumonia.
  
  
  METHODS
  A search of MEDLINE and Ovid databases was conducted (January 1970-May 2011) using the search terms Legionella pneumophila, pneumonia, Legionnaires' disease, rifampin or rifampicin, macrolide, fluoroquinolone, erythromycin, clarithromycin, levofloxacin, ciprofloxacin, and moxifloxacin
  
  
  METHODS
  In vivo studies published in English that compared antimicrobial therapies including rifampin for the treatment of Legionella pneumonia, as well as in vitro studies including an assessment of rifampin bioactivity, were included.
  
  
  RESULTS
  Macrolides and fluoroquinolones have been effective as monotherapy in the treatment of L. pneumophila pneumonia. This review includes evidence summaries from 4 bioactivity evaluations, 6 clinical studies, and 6 reported cases of combination rifampin use. Combined with supporting evidence, the role of combination rifampin therapy is further delineated.
  
  
  CONCLUSIONS
  Interpretation of the data is limited by the potential for selection bias and lack of consistent comparators. Rifampin therapy should be considered only for patients with severe disease or significant comorbid conditions (eg, uncontrolled diabetes, smoking, or obstructive lung disease) including immunocompromised hosts and those refractory to conventional monotherapy regimens. Caution for significant adverse drug events and drug-drug interactions should be taken with the addition of rifampin.
authors.affiliation: Department of Pharmacy, Palmetto Health Richland, Columbia, SC, USA.
authors.forename: Terra R
authors.initials: TR
authors.lastname: Varner
authors.forename: P Brandon
authors.initials: PB
authors.lastname: Bookstaver
authors.forename: Celeste N
authors.initials: CN
authors.lastname: Rudisill
authors.forename: Helmut
authors.initials: H
authors.lastname: Albrecht
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004347:Drug Interactions; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006801:Humans; D016952:Legionella pneumophila / Q000187:drug effects*; D007877:Legionnaires' Disease / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D019384:Nucleic Acid Synthesis Inhibitors / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D012293:Rifampin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D019384:Nucleic Acid Synthesis Inhibitors; D012293:Rifampin