What is the best treatment for an ICU patient?

There is a patient in the ICU that has been diagnosed with Legionnaires’ disease. She was diagnosed with a positive Legionella serology test.


She has had a masectomy on one breast. She has a pacemaker. She also has had chronic spinal issues and walks with the aid of a walker.


What is the correct treatment for a patient who requires such intensive care? She is in the ICU and has been on a ventilator for about five days now. Her vital signs are looking pretty good and her heart is strong, but she is not getting better.

The drugs of choice for Legionnaires’ disease are:

Quiniolones: levofloxacin, moxifloxican

Macrolides: azithromycin, clarithromycin

Most patients who receive correct treatment early respond within five days (fever will disappear).  If she is receiving one of these antibiotics, she is being treated correctly. If an infection disease specialist is a consultant, I would guess that everything is being done for her and her care is appropriate.

Regardless, ICU physicians are well trained and knowledgeable about Legionnaires’ disease. The biggest problems in patients with Legionnaires’ disease is that disease is often overlooked by physicians. Your physicians have already made a correct diagnosis.

If she is deteriorating, we may recommend the addition of rifampin (600 mg/day) for only 3-5 days. This does not need to be done if an improvement is seen. Good luck.