Approach

Antibiotic treatment is the main option for community-acquired pneumonia due to Chlamydia pneumoniae.[13]

Adults

Chlamydia pneumoniae is susceptible to tetracyclines, macrolides, and fluoroquinolones, all of which are equal first-line options. Most of the published treatment studies of pneumonia caused by C pneumoniae have relied entirely on diagnosis by serology; consequently, microbiologic efficacy could not be assessed. Anecdotal reports have suggested that prolonged courses, up to 3 weeks, of either tetracyclines or erythromycin may be needed to eradicate C pneumoniae from the nasopharynx of adults with flu-like illness and pharyngitis. Fluoroquinolones, including levofloxacin and moxifloxacin, are very effective in the treatment of C pneumoniae in adults.[14][15] 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.[16][17] The Food and Drug Administration (FDA) has also issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[18][19]

Most patients will improve clinically despite persistence of the organism.[14][20][21][22] Persistence does not appear to be secondary to the development of antibiotic resistance.[14][15][22]

Children

Recommended treatment is with macrolides.[20][21]

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