Published in:
01-10-2019 | Macrolide | Correspondence
Macrolides or fluoroquinolones as enteral antibiotic therapy for non-ICU legionellosis
Published in: Infection | Issue 5/2019
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While legionellosis incidence has increased in Europe, up to 21% from 2012 to 2016 [1], the choice between fluoroquinolones or macrolides as first-line antibiotic therapy remains controversial. Indeed, a meta-analysis of 2014 [2] included 12 studies with some favoring fluoroquinolones and some macrolides, with a 0.5 mortality odds ratio for fluoroquinolones, but it was not significant. Length of stay (LOS) was shorter. In a recent study [3], which is the biggest series (446 legionellosis), no difference was found for mortality, LOS, and duration of fever. Herein we report the results of our cohort of patients presenting with legionellosis treated according to our internal guideline advising enteral macrolide since April 2008. Roxithromycin was selected among macrolide, for which there is no parenteral form (Table 1).
Table 1
Comparison of patients according to antibiotic treatment for legionellosis
|
Macrolides
n = 55 (47%)
|
Fluoroquinolones
n = 39 (33%)
|
p
|
Other antibiotic therapies
n = 24 (20%)
|
|
|---|---|---|---|---|
|
Mean age (years)
|
60
|
62
|
0.71
|
61
|
|
Men (%)
|
41 (75)
|
25 (64)
|
0.55
|
17 (70)
|
|
Comorbidity
|
||||
|
Cardiovascular
|
15 (27)
|
11 (28)
|
0.29
|
13 (54)
|
|
Respiratory
|
21 (38)
|
8 (21)
|
0.12
|
10 (42)
|
|
Neurologic
|
5 (9)
|
5 (13)
|
0.52
|
1 (4)
|
|
Cancer
|
1 (2)
|
1 (3)
|
0.32
|
2 (8)
|
|
Hepatobiliary
|
9 (16)
|
11 (28)
|
0.36
|
6 (25)
|
|
Diabetes
|
8 (14)
|
2 (5)
|
0.16
|
5 (21)
|
|
Renal
|
8 (14)
|
1 (3)
|
0.09
|
1 (4)
|
|
Mean PSI
|
83
|
80
|
0.69
|
88
|
|
Failure of treatment
|
4 (7.1%)
|
4 (10.3%)
|
0.46
|
4 (16.6%)
|
|
Length of stay (days)
|
6.8
|
9.1
|
0.047
|
8.9
|
|
Death
|
1 (1.8%)
|
1 (2.5%)
|
ns
|
2 (8.3%)
|