How to Treat Legionellosis

Legionellosis is a bacterial infection caused by the Legionella pneumophila bacterium. It takes two forms: Pontiac fever, which is the mild form of the disease, and Legionnaires' disease, which includes pneumonia. This bacterium was first identified at a 1976 convention of the American Legion in Philadelphia, but earlier cases have been identified as far back as 1947. The following steps will show how to treat a case of legionellosis.

Difficulty: Challenging

Instructions

1. Hospitalize patients with mild-to-moderate Legionella pneumonia. Mild cases can be treated on an outpatient basis with oral antibiotics. The full course of antibiotic treatment should always be completed. Pontiac fever does not require specific treatment.

2. Begin intravenous antibiotic therapy and supportive measures as soon as Legionnaires' disease is suspected. Don't wait for test results. Empiric antibiotic therapy must be comprehensive and cover all likely pathogens in the clinical setting.

3. Administer azithromycin, doxycycline, macrolides or quinolones. Erythromycin generally has been used, but these newer drugs are more effective and have better availability, longer half-lives and better penetration into the microphages.

4. Add a fluoroquinolone or rifampin to the treatment for severe cases. Rifampin does not need to be added to doxycycline.

5. Continue the therapy until the patient improves, and then consider changing to an oral antibiotic for 10 to 14 days. Antibiotic should be continued for 21 days in the case of patients with Legionella pneumonia, suppressed immune systems or severe underlying diseases. Patients should have close follow-up care to ensure their respiratory symptoms have resolved.

Resources

• Learn more about legionellosis at OSHA.

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