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Legionella: macrolides or quinolones?

L Pedro-Botet¹, V L Yu

¹Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases

|May 4, 2006

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Quinolones show greater efficacy than macrolides for treating legionnaire's disease in lab and animal models. Observational studies suggest quinolones may also offer superior clinical response in patients.

Area of Science:

Infectious Diseases
Pharmacology
Microbiology

Background:

Erythromycin was initially the primary treatment for legionnaire's disease, but therapeutic failures and side effects prompted research into alternatives.
Newer macrolides and quinolones emerged in the 1990s as potential treatments for legionnaire's disease.

Purpose of the Study:

To review and compare the efficacy of macrolides and quinolones in treating legionnaire's disease.
To evaluate in vitro, animal, and observational human studies comparing these antibiotic classes.

Main Methods:

A review of 19 in vitro intracellular model studies and 7 animal studies comparing macrolides and quinolones.
Analysis of three observational studies involving 458 patients comparing macrolides (excluding azithromycin) and quinolones (primarily levofloxacin).

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Main Results:

Quinolones demonstrated superior activity in intracellular models and improved efficacy in animal models compared to macrolides.
Observational studies indicated that quinolones may lead to better clinical outcomes, including faster fever reduction, fewer complications, and shorter hospital stays than macrolides (erythromycin, clarithromycin).

Conclusions:

Quinolones appear more effective than macrolides in preclinical models of legionnaire's disease.
While observational data suggest clinical superiority of quinolones, no randomized controlled trials have directly compared new macrolides and quinolones.
Further research is needed, especially for direct comparisons between quinolones and azithromycin.