In this episode, I’ll discuss macrolides vs. fluroquinolones for legionella pneumonia.
Traditionally it is thought that a bacteriocidal antibiotic is preferable to a bacteriostatic one, especially in severe infections such as legionella pneumonia. However, the IDSA guidelines recommend that either a fluoroquinolone or a macrolide may be used first-line in the treatment of Legionella pneumonia. Recently a systematic review and meta-analysis was completed to determine which antibiotic class leads to optimal clinical outcomes in legionella pneumonia.
21 randomized controlled trials and observational studies that compared macrolide vs. fluoroquinolone monotherapy were included. These studies represented over 3500 patients.
The mortality rate for patients treated with fluoroquinolones was 6.9% (104/1512) compared to 7.4% (133/1790) among those treated with macrolides. The pooled OR assessing risk of mortality for patients treated with fluoroquinolones vs macrolides was 0.94 (95% CI 0.71-1.25, I2=0%, p= 0.661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones vs. macrolides.
The authors concluded that there was no difference in the effectiveness of fluoroquinolones vs. macrolides in reducing mortality among patients with Legionella pneumonia. This study supports the IDSA guideline recommendation in that clinicians may choose either a fluoroquinolone or a macrolide for treatment of legionella pneumonia.
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