Extract

Sir,

Legionella pneumophila is an ‘atypical’ pathogen associated with lower respiratory tract infections (RTIs) such as community-acquired pneumonia (CAP).1 Organizations such as the Infectious Diseases Society of America recommend that empirical treatment of CAP should cover atypical pathogens such as L. pneumophila and Chlamydophila (Chlamydia) pneumoniae.2 At present, macrolides and fluoroquinolones are the most active options against atypical pathogens. On the contrary, β-lactams are inactive against these pathogens.

Iclaprim is a new dihydrofolate reductase inhibitor, which recently completed enrolment in two Phase III trials of complicated skin and skin structure infections treated via intravenous administration and has recently successfully completed Phase I investigations of an oral formulation. Currently, the only clinically available antibiotic targeting dihydrofolate reductase is trimethoprim. This antibiotic can be used in combination with sulphonamides such as sulfamethoxazole, although rarely these days due to concerns over toxicity with sulfamethoxazole. At present, data on the activity of iclaprim against L. pneumophila have not been published.

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