Efficacy of intravenous spiramycin in the treatment of severe Legionnaires' disease.

Spiramycin is a 16-membered macrolide that has been shown in cell and animal models to be active against Legionella spp. The activity of the injectable form of spiramycin was evaluated in the treatment of severe Legionnaires' disease in seven immunocompromised and three previously healthy patients. Seven of the ten patients were cured. Three patients died primarily from the underlying disease or from intercurrent complications. This result and the better tolerance of spiramycin compared with 14-membered macrolides suggest that spiramycin may be a suitable alternative to erythromycin for the treatment of Legionnaires' disease.