ABSTRACT
This chapter reviews the available data on the efficacy of erythromycin, tetracycline, rifampin, and other antimicrobials. It is clear that the prognosis is correlated closely with early therapy with an effective agent. Therapy must usually be intensive and prolonged. Tetracyclines are the preferred alternative agents in the treatment of Legionnaires' disease on the basis of experience to date. In the Philadelphia epidemic, 90% of patients receiving tetracycline survived — a case/fatality ratio comparable to that seen with erythromycin. A renal transplant patient with cavitary pneumonia due to L. micdadei had persistent symptoms and radiographic abnormalities on erythromycin plus rifampin. No clinical response was documented with penicillin, cephalothin, cefoxitin, or aminoglycoside therapy for up to several weeks in most reports of infections caused by L. micdadei, L. bozemanii, L. dumoffii, or L. longbeachae. The concerted involvement of clinicians, nursing staffs, laboratory personnel, and often the respiratory therapy and dialysis teams, is required for a successful outcome.
