To provide clinical data on fluoroquinolone treatment of severe pulmonary tularaemia and describe outcomes from a series of patients treated at a center in Austria from December 2023 to December 2025.
Approach:
Patient Cases: Six patients with pulmonary tularaemia were analyzed, all presenting with acute febrile illness and varying levels of oxygenation support.
Diagnostic Methods: Diagnosis was confirmed through microbiological evidence of F. tularensis subsp. holarctica, including PCR and blood cultures.
Treatment Regimens: Patients received empiric broad-spectrum antimicrobials initially, followed by targeted therapy with fluoroquinolones and doxycycline.
Key Findings:
All patients showed marked systemic inflammation and pulmonary involvement.
Five out of six patients required a switch to targeted therapy after initial broad-spectrum treatment was ineffective.
Interpretation:
The findings suggest that fluoroquinolones may be a viable alternative to aminoglycosides for treating severe pulmonary tularaemia, especially in cases where initial broad-spectrum therapy fails. The rapid clinical deterioration observed in these patients underscores the need for timely diagnosis and effective treatment strategies.
Limitations:
This case series is limited by its small sample size and the lack of a control group, which restricts the generalizability of the findings. Additionally, the retrospective nature of the analysis may introduce biases in patient selection and treatment outcomes. Further studies with larger cohorts and randomized controlled trials are necessary to validate these findings.
Conclusion:
This case series highlights the potential effectiveness of fluoroquinolones in managing severe pulmonary tularaemia, warranting further investigation into their role in treatment protocols for this serious infection. ---
