Quinolones and Macrolides Effective Against Legionella Pneumonia

The treatment of Legionella pneumonia, particularly in cases of respiratory failure, has been a subject of debate within the medical community. A recent systematic review conducted between 2012 and 2022 found quinolones and macrolides equally effective in managing this severe respiratory infection. The findings were published in Journal of Internal Medicine.

The comprehensive review involved a thorough search of databases including PubMed, Cochrane Library, and Web of Science, resulting in the identification of ten observational studies meeting the inclusion criteria. These studies encompassed a substantial cohort of 4,271 patients, with 67% being male. A significant portion of the subjects, 42%, required admission to the intensive care unit (ICU), and 52% needed mechanical ventilation to support their compromised respiratory function.

In terms of the antibiotics used, 33% of patients received fluoroquinolones, 35% were treated with macrolides, and 4.8% received a combination therapy. The study found that the overall mortality rate was 7.4%, with no significant difference observed between the two types of antibiotics.

However, when the data from three studies focusing on severe pneumonia cases were pooled together, a notable discrepancy emerged. In these severe cases, treatment with fluoroquinolones alone demonstrated statistically superior results compared to macrolides alone, with mortality rates of 72.8% versus 30.8%, respectively, and a p-value of 0.027.

In contrast, the study found that hospital length of stay and the incidence of complications were comparable between the two antibiotic groups.

These findings suggest that, for hospitalized patients with Legionella pneumonia, both macrolides and quinolones are equally effective in terms of mortality rates. However, when dealing with severe cases, where the stakes are higher, fluoroquinolones appear to have an edge.

It's important to note that this study highlights the need for further research, particularly in the context of severe Legionella pneumonia. A randomized clinical trial specifically focused on this subgroup is deemed an unmet clinical requirement, which could provide more precise guidelines for the management of this severe respiratory infection.

While the debate on the optimal antibiotic regimen for Legionella pneumonia treatment continues, this systematic review offers valuable insights, emphasizing the importance of tailoring treatment strategies to the severity of the condition.

Source:

Ruiz-Spinelli, A., & Rello, J. (2023). Legionella pneumonia in hospitalized adults with respiratory failure: Quinolones or macrolides? In European Journal of Internal Medicine. Elsevier BV. https://doi.org/10.1016/j.ejim.2023.09.013