Legionella-Infection-Treatment-
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For Legionnaires illness (LD), a high level of feeling and prompt initiation of adequate antimicrobial therapy are essential to enhance clinical outcomes.[27] On the other hand, for Pontiac fever, treatment is symptomatic, and no antimicrobial therapy is recommended. opstellen legionella beheersplan Treatment successful in patients with legionellosis should be considered for initial empirical therapy for serious community-acquired pneumonia (CAP) and for particular patients with nosocomial pneumonia. Service treatment in patients with respiratory and shock failure is given as needed. Conditions suggesting Legionella disease: - Gram stains of respiratory samples exposing many polymorphonuclear leukocytes with few or no organisms legionella besmettelijk Hyponatremia - Pneumonia with outstanding extrapulmonary manifestations (eg, diarrhoea, frustration, other neurologic signs) - Failure to respond to administration of beta-lactams, aminoglycoside antibiotics, or both - Antimicrobial therapy for Legionella disease Specific treatment includes antibiotics with the capacity of reaching high intracellular concentrations (eg, macrolides, quinolones, ketolides, tetracyclines, rifampin). The described rank order of in intracellular and vitro action against L pneumophila is quinolones, then ketolides, and then macrolides[28].. Beta-lactams and aminoglycosides have action against Legionella species in vitro but are not clinically effective. No prospective randomized studies have already been done regarding antibiotic success in patients with Legionella illness. Recommendations are based on retrospective evaluations and experimental animal) and (laboratory studies. Azithromycin is the drug of choice for kids with suspected or confirmed Legionella disease.[1] With rare exceptions, the first course should be intravenously administered. It may be turned to the oral route, after a good clinical response is seen. In patients with severe illness or who be seemingly unresponsive to monotherapy, the addition of rifampin is advised. Specific fluoroquinolones (eg, levofloxacin, moxifloxacin) are powerful and are recommended for adults with severe disease.[29] Because macrolides might interfere with drugs metabolized by cytochrome P450 (CYP) 3A4 isoenzyme (eg, cyclosporine), the quinolones mentioned previously are suitable alternatives to treat Legionnaires infection in patients taking cyclosporine and other CYP3A4 substrates. An older fluoroquinolone, ciprofloxacin, does inhibit CYP3A4. Even though the US Food and Drug Administration (FDA) has not authorized fluoroquinolones for individuals younger than 18 years (because of concerns about arthropathy in studies of juvenile animals), they have been successfully used to take care of children with Legionnaires disease[2, 30, 12] and may be used in children in special circumstances. Other alternatives incorporate doxycycline or trimethoprim (TMP) and sulfamethoxazole (SMZ). click here The recommended duration of therapy is 5-10 days if azithromycin is employed. The length must be 2-3 months, if other drugs are used. For patients with severe infection or immunocompromise, extended courses might be needed.
