Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

adults

1st line – macrolides or fluoroquinolones or tetracyclines

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ACUTE
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adults
1st line – 

macrolides or fluoroquinolones or tetracyclines

Data on microbiological efficacy based on culture are limited; the results of three published treatment studies in adults that used cultures demonstrated 70% to 80% eradication of Chlamydia pneumoniae from the respiratory tract in adults with community-acquired pneumonia after treatment with azithromycin, levofloxacin, or moxifloxacin.[13][14][21] These three drugs appear to be equivalent and can be considered first-line.

Tetracyclines, specifically doxycycline, are also used first-line.

Tetracyclines and fluoroquinolones cannot be used in pregnant women. Treatment in this group should be with a macrolide (azithromycin, clarithromycin, or erythromycin).

Fluoroquinolones are associated with serious, disabling, and potentially irreversible adverse effects including tendonitis, tendon rupture, arthralgia, neuropathies, and other musculoskeletal or nervous system effects.[15][16] The Food and Drug Administration (FDA) has also issued warnings about the increased risk of aortic dissection, significant hypoglycaemia, and mental health adverse effects in patients taking fluoroquinolones.[17][18]

Primary options

azithromycin: 500 mg orally once daily on day one, followed by 250 mg once daily for 4 days

OR

levofloxacin: 500 mg orally/intravenously once daily for 7-14 days

OR

moxifloxacin: 400 mg orally/intravenously once daily for 10 days

OR

doxycycline: 100 mg orally twice daily for 14-21 days

OR

tetracycline: 250 mg orally every 6 hours for 14-21 days

OR

clarithromycin: 250 mg orally twice daily for 10 days

OR

erythromycin base: 500 mg orally every 6 hours for 14-21 days

children

1st line – macrolides

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ACUTE
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children
1st line – 

macrolides

Treatment is with either a 10-day course of erythromycin or clarithromycin, or a 5-day course of azithromycin suspension.[19][20]

All these regimens have demonstrated 80% efficacy in eradication of Chlamydia pneumoniae from the respiratory tract of children.

Primary options

erythromycin base: 50 mg/kg/day orally given in divided doses every 6 hours for 10-14 days

OR

clarithromycin: 15 mg/kg/day orally given in divided doses every 12 hours for 10 days

OR

azithromycin: 10 mg/kg/day orally on day one, followed by 5 mg/kg/day for 4 days

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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