Table 3.
Therapeutic options for adult patients with severe pneumonia from Legionella pneumophila
| Therapy | Normal Adult Dose | Comments |
|---|---|---|
| Macrolides | Azithromycin 500 mg IV every 24 h or clarithromycin 500 mg IV every 12 h | Preferred regimen in most settings, or a fluoroquinolone |
| Fluoroquinolones | Levofloxacin (500 mg IV/d) or moxifloxacin 400 mg IV once daily | Generally well tolerated and effective |
| Rifampin | 300–600 mg IV every 12 h | Multiple drug interactions, including warfarin, opiates, cyclosporine, antiretroviral protease inhibitors; used with a macrolide or quinolone |
| Doxycycline | 200-mg IV loading dose followed by 100 mg IV every 12 h | Limited clinical experience shows activity |
| Combinations | Levofloxacin (500 mg IV/d) or another fluoroquinolone + azithromycin (500 mg IV every 24 h); consider adding rifampin to monotherapy despite many drug interactions | No clear evidence of efficacy of combination therapy compared with monotherapy; often used in SCAP with extensive disease in high-risk patients failing monotherapy |
| Corticosteroids | 0.5–1 mg/kg/d | No clinical evidence of benefit at present in patients with SCAP from legionellosis; awaiting clinical trial evidence |