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23 Iyar 5761 - May 16, 2001 | Mordecai Plaut, director Published Weekly
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Home and Family
Your Medical Questions Answered! by Joseph B. Leibman, MD

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.

 

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