Legionella Infection Medication

  • Author: Mobeen H Rathore, MD, CPE, FAAP, FIDSA; Chief Editor: Russell W Steele, MD   more...
 
Updated: Oct 25, 2011
 

Medication Summary

Early initiation of antibiotic therapy with antilegionellosis agents substantially reduces the mortality rate.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the clinical setting. Whenever feasible, select antibiotics on the basis of blood-culture sensitivity.

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Azithromycin (Zithromax)

 

Binds to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis. Nucleic acid synthesis not affected. Concentrates in phagocytes and fibroblasts, as demonstrated with in vitro incubation techniques. In vivo data suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. Used to treat mild-to-moderate microbial infections. Plasma concentrations are low but tissue concentrations are high, giving it value in treating intracellular organisms. Has long tissue half-life, and single dose recommended.

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Rifampin (Rifadin)

 

Use with azithromycin. 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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Doxycycline (Doryx, Vibramycin)

 

Broad-spectrum, synthetically derived bacteriostatic antibiotic in tetracycline class. Almost completely absorbed, concentrated in bile, and excreted in urine and feces as biologically active metabolite in high concentrations.

Inhibits protein synthesis and therefore bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl t-RNA from ribosomes, arresting RNA-dependent protein synthesis.

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Ciprofloxacin (Cipro)

 

Fluoroquinolone that inhibits bacterial DNA synthesis and consequently growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. No activity against anaerobes. Continue for at least 2 d (7-14 d typical) after signs and symptoms disappear.

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Levofloxacin (Levaquin)

 

Fluoroquinolone antibiotic for pseudomonal infections and infections caused by multidrug-resistant gram-negative organisms.

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Trimethoprim and sulfamethoxazole, TMP-SMZ (Bactrim, Septra)

 

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity against common urinary tract pathogens, except Pseudomonas aeruginosa.

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Contributor Information and Disclosures
Author

Mobeen H Rathore, MD, CPE, FAAP, FIDSA  Chief of Division of Pediatric Infectious Diseases/Immunology, Associate Chairman of Department of Pediatrics, University of Florida College of Medicine at Jacksonville; Hospital Epidemiologist and Section Chief of Infectious Disease and Immunology, Wolfson Children's Hospital; Director of University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES)

Mobeen H Rathore, MD, CPE, FAAP, FIDSA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, European Society for Paediatric Infectious Diseases, Florida Medical Association, Florida Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America, Society for Pediatric Research, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Ana Alvarez, MD  Associate Professor of Pediatrics, Pediatric Infectious Diseases Fellowship Director, University of Florida College of Medicine, Jacksonville

Ana Alvarez, MD is a member of the following medical societies: American Academy of Pediatrics, Florida Medical Association, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Glenn Fennelly, MD, MPH  Director, Division of Infectious Diseases, Lewis M Fraad Department of Pediatrics, Jacobi Medical Center; Clinical Associate Professor of Pediatrics, Albert Einstein College of Medicine

Glenn Fennelly, MD, MPH is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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