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BACKGROUND The Infectious Diseases Society of America recommends either a fluoroquinolone or a macrolide as a first line antibiotic treatment for Legionella pneumonia, but it is unclear which antibiotic leads to optimal clinical outcomes. We compare the effectiveness of fluoroquinolone versus macrolide monotherapy in Legionella pneumonia using a systematic review and meta-analysis. METHODS We conducted a systematic search of literature in PubMed, Cochrane, Scopus and Web of Science from inception to June 1, 2019. Randomized controlled t