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Antimicrobial Agents and Chemotherapy, January 2003, p. 446, Vol. 47, No. 1
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.1.446.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Use of Macrolides for Q Fever


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LETTER
 
Gikas et al. report on the use of macrolides as empirical treatment for acute Q fever infection (1). This is of interest as few works have been performed to evaluate empirical therapy of Q fever pneumonia. However, I believe that one should be cautious before recommending erythromycin in this indication based on such results. In this work no patient treated with doxycycline was febrile after 4 days of treatment whereas more than 30% of those treated by erythromycin were. This difference was highly significant (P = 0.005). As stated by the authors, there are many discrepancies in the literature as to the clinical efficacy of erythromycin. We believe that this is correlated with a heterogeneity of susceptibility among Coxiella burnetii isolates. In our work testing 13 strains we found that 6 of the 13 were completely resistant to erythromycin (3). The discrepancies about erythromycin efficiency among the series could partly reflect the level of resistance of the local strains. Altogether these data are not in favor of the use of erythromycin for Q fever, and I believe that the role of the new macrolides for which no antibiotic resistance was detected, such as clarithromycin (2) and telithromycin (4), should be further investigated.


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FOOTNOTES
 
Ed. Note: The authors of the published article declined to respond.


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REFERENCES
 
    1
  1. Gikas, A., D. P. Kofteridis, A. Manios, J. Pediaditis, and Y. Tselentis. 2001. Newer macrolides as empiric treatment for acute Q fever infection. Antimicrob. Agents Chemother. 45:3644-3646.[Abstract/Free Full Text]
    2. 2
  2. Gikas, A., I. Spyridaki, A. Psaroulaki, D. Kofterithis, and Y. Tselentis. 1998. In vitro susceptibility of Coxiella burnetii to trovafloxacin in comparison with susceptibilities to pefloxacin, ciprofloxacin, ofloxacin, doxycycline, and clarithromycin. Antimicrob. Agents Chemother. 42:2747-2748.[Abstract/Free Full Text]
    3. 3
  3. Raoult, D., H. Torres, and M. Drancourt. 1991. Shell-vial assay: evaluation of a new technique for determining antibiotic susceptibility, tested in 13 isolates of Coxiella burnetii. Antimicrob. Agents Chemother. 35:2070-2077.[Abstract/Free Full Text]
    4. 4
  4. Rolain, J. M., M. Maurin, A. Bryskier, and D. Raoult. 2000. In vitro activities of telithromycin (HMR 3647) against Rickettsia rickettsii, Rickettsia conorii, Rickettsia africae, Rickettsia typhi, Rickettsia prowazekii, Coxiella burnetii, Bartonella henselae, Bartonella quintana, Bartonella bacilliformis, and Ehrlichia chaffeensis. Antimicrob. Agents Chemother. 44:1391-1393.[Abstract/Free Full Text]
Didier Raoult
Unité des Rickettsies
CNRS UMR 6020
Faculté de Médecine
Université de la Méditerranée
27, Boulevard Jean Moulin
13385 Marseille Cedex 05, France

Phone: 33 4 91 32 44 12, Fax: 33 4 91 38 77 72, E-mail: Didier.Raoult{at}medecine.univ-mrs.fr

Antimicrobial Agents and Chemotherapy, January 2003, p. 446, Vol. 47, No. 1
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.1.446.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.




This Article
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