Legionnaires Disease in Emergency Medicine Medication

  • Author: Frank C Smeeks lll, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 31, 2011
 

Medication Summary

Standard antibiotic susceptibility tests are not reliable in Legionnaires disease. Resistance to commonly prescribed front-line agents has not been problematic. First-line therapy consists of either fluoroquinolones (levofloxacin) or azithromycin. Erythromycin, with or without rifampin, is effective for Legionnaires disease, but the combined GI manifestations of the disease added to the GI effects of erythromycin may be problematic. For this reason, some specialists prefer doxycycline. Other drugs include cotrimoxazole, tetracycline, and ciprofloxacin. When illness is severe or GI complications preclude the use of oral medications, intravenous antibiotics and hospitalization should be utilized. Duration of therapy depends on the agent utilized as well as the severity of infection and the immunological competence of the patient. Pontiac fever is usually self-limited and does not typically require antibiotic therapy.

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Antibiotics

Class Summary

Therapy must cover all likely pathogens in the context of the clinical setting.

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Levofloxacin (Levaquin)

 

Primarily excreted in urine (87% unchanged).

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Azithromycin (Zithromax)

 

Liver metabolism (CYP 45) with bile excretion (>50% unchanged).

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Erythromycin (Ery-Tab, Erythrocin, EES)

 

Metabolized in liver and excreted primarily by bile. Inhibits RNA-dependent protein synthesis, possibly by stimulating dissociation of peptidyl t-RNA from ribosomes. This inhibits bacterial growth.

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Doxycycline (Doryx, Bio-Tab)

 

Second DOC; interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria.

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Rifampin (Rifadin, Rimactane)

 

DOC to use with erythromycin. Inhibits DNA-dependent RNA polymerase activity in susceptible cells. Specifically, interacts with bacterial RNA polymerase, but does not inhibit mammalian enzyme.

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Contributor Information and Disclosures
Author

Frank C Smeeks lll, MD  Chief Medical Officer, Frye Regional Medical Center

Frank C Smeeks lll, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and North Carolina Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Jeter (Jay) Pritchard Taylor III, MD  Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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This electron micrograph depicts an amoeba, Hartmannella vermiformis (orange), as it entraps a Legionella pneumophila bacterium (green) with an extended pseudopod. After it is ingested, the Legionella pneumophila bacterium can survive as a symbiont within what then becomes its protozoan host. The amoeba then becomes what is referred to as a "Trojan horse," for by harboring the pathogenic bacteria, the amoeba can afford them protection, and in fact, in times of adverse environmental conditions, are able to metamorphose into a cystic-stage enabling it, and its symbiotic resident pathogens to withstand such environmental stresses. Image courtesy of the Centers for Disease Control and Prevention and Dr. Barry S Fields.
 
 
 
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