Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
Sometimes, you just remember where you were when certain
things occur. I went to a summer camp where I was the only
one not from New York and as such suffered a lot of kidding
from my fellow campers. I remember being outside the camp
dining room when one camper joked about some epidemic which
was plaguing people in Philadelphia, my home city. The real
story was that a fraternal organization of elderly war
veterans called the American Legion was meeting in the
luxurious Bellevue Stratford Hotel in the summer of 5736
(1976). Many of these men came down with a mysterious
respiratory disease that did not grow in culture and while
looking clinically like pneumonia, the X-rays barely showed
any abnormality at all. 27 of these Legionnaires died before
the microorganism was discovered, and it was named
appropriately "Legionella" the cause of Legionnaire's
disease.
This disease is now known to be all over, and it especially
likes to grow in moist places, like the air conditioning
units of the hotel where this convention was held. We now
know that the disease responds well to Erythromycin and
related drugs.
A second epidemic happened in the eighties, when sprinkler
systems were used in supermarkets to keep vegetables fresh,
and these aerosols frequently contained this organism.
Related atypical pneumonias were soon discovered, including
Chlamydia, a common unusual pneumonia often found in
teenagers; and mycoplasma, another unusual organism that
causes bronchitis and pneumonia and occasionally arthritis.
Interestingly enough, these last two agents are often found
in people with heart disease, making us wonder if
antibiotics may prevent heart attacks. The research is still
ongoing. These pneumonias all respond well to the
erythromycin family and may only become a problem in the
elderly.
Since these pneumonias, which are common in young people,
respond to this antibiotic and most other pneumonias in
younger people also respond well to this drug; most experts
recommend this family of antibiotics, which includes
azithromycin (Azenil, Zeto in Israel, Zihromax in the USA),
Clarithyromycin (Klacid, Karin in Israel, Bidxin in the
USA), erythromycin, and Roxithromycin (Rulid in Israel). Our
sponsor's drug Zinnat, and their other drug Augmentin do not
cover these organisms, so in the elderly at high risk, a
combination of these two drugs is recommended. These latter
two drugs all cover more of the unusual bacteria that may
infect an elderly person and there is less resistance to
them.
I should point out that upper respiratory tract infections
and bronchitis in a nonsmoker do not need antibiotics. As I
have often said, my point is not to make you into doctors,
but rather educated consumers. Write me in care of the
Yated.
