Chemotherapy of Legionnaires' Disease with Macrolide or Quinolone Antimicrobial Agents

TL;DRAbstract

Effective antimicrobial chemotherapy of Legionnaires' disease is driven primarily by the location of Legionella pneumophila inside cells, primarily alveolar macrophages. Determining optimal chemotherapy for Legionnaires' disease by conducting truly informative clinical trials is generally of little use since the disease is uncommon and because the fatality rates in most community-acquired cases are relatively low. For effective chemotherapy to occur there must be colocalization of the bacterium and antimicrobial agents, and the antimicrobial agent must retain bioactivity against the bacterium. The β-lactam drugs are instead found in the cytosol, probably the main reason why they are ineffective in the treatment of Legionnaires' disease. In cell culture model, erythromycin therapy results in survival rates that are the same for azithromycin or active quinolone antimicrobial agents. A number of obstacles have prevented such studies, including the great cost of diagnostic testing for Legi

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