Pacientes com infecção respiratória por Chlamydia pneumoniae documentada por cultura, inclusive pneumonia adquirida na comunidade, geralmente respondem bem ao tratamento antibiótico com rápida remissão dos sintomas.[11]Gray GC, Witucki PJ, Gould MT, et al. Randomized, placebo-controlled clinical trial of oral azithromycin prophylaxis against respiratory infections in a high-risk young adult population. Clin Infect Dis. 2001 Oct 1;33(7):983-9.
http://cid.oxfordjournals.org/content/33/7/983.long
http://www.ncbi.nlm.nih.gov/pubmed/11528569?tool=bestpractice.com
[12]Kohlhoff SA, Hammerschlag MR. Treatment of chlamydial infections: 2014 update. Expert Opin Pharmacother. 2015 Feb;16(2):205-12.
http://www.ncbi.nlm.nih.gov/pubmed/25579069?tool=bestpractice.com
Por volta de 10% dos pacientes podem precisar de um segundo ciclo de tratamento. A Chlamydia pneumoniae pode persistir no trato respiratório após a doença aguda por períodos de 6 meses ou mais.[22]Hammerschlag MR, Chirgwin K, Roblin PM, et al. Persistent infection with Chlamydia pneumoniae following acute respiratory illness. Clin Infect Dis. 1992 Jan;14(1):178-82.
http://www.ncbi.nlm.nih.gov/pubmed/1571425?tool=bestpractice.com
[23]Emre U, Roblin PM, Gelling M, et al. The association of Chlamydia pneumoniae infection and reactive airway disease in children. Arch Pediatr Adolesc Med. 1994 Jul;148(7):727-32.
http://www.ncbi.nlm.nih.gov/pubmed/8019629?tool=bestpractice.com
No entanto, a maioria dos pacientes apresenta melhora clínica, mesmo com a persistência do organismo.[13]Hammerschlag MR, Roblin PM. Microbiologic efficacy of levofloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Antimicrob Agents Chemother. 2000 May;44(5):1409.
http://aac.asm.org/cgi/content/full/44/5/1409
http://www.ncbi.nlm.nih.gov/pubmed/10819727?tool=bestpractice.com
[14]Hammerschlag MR, Roblin PM. Microbiologic efficacy of moxifloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Int J Antimicrob Agents. 2000 Jul;15(2):149-52.
http://www.ncbi.nlm.nih.gov/pubmed/10854812?tool=bestpractice.com
[19]Block S, Hedrick J, Hammerschlag MR, et al. Mycoplasma pneumoniae and Chlamydia pneumoniae in community acquired pneumonia in children: comparative safety and efficacy of clarithromycin and erythromycin suspensions. Pediatr Infect Dis J. 1995 Jun;14(6):471-7.
http://www.ncbi.nlm.nih.gov/pubmed/7667050?tool=bestpractice.com
[20]Harris J-A, Kolokathis A, Campbell M, et al. Safety and efficacy of azithromycin in the treatment of community acquired pneumonia in children. Pediatr Infect Dis J. 1998 Oct;17(10):865-71.
http://www.ncbi.nlm.nih.gov/pubmed/9802626?tool=bestpractice.com
[21]Roblin PM, Hammerschlag MR. Microbiologic efficacy of azithro-mycin and susceptibility to azithromycin of isolates of Chlamydia pneumoniae from adults and children with community acquired pneumonia. Antimicrob Agents Chemother. 1998 Jan;42(1):194-6.
http://aac.asm.org/cgi/content/full/42/1/194
http://www.ncbi.nlm.nih.gov/pubmed/9449287?tool=bestpractice.com
A resistência antibiótica verdadeira de C pneumoniae em pacientes após o tratamento não foi demonstrada. Testes de sensibilidade in vitro de isolados obtidos de pacientes com infecção persistente não demonstraram qualquer alteração dos isolados obtidos na linha basal.[13]Hammerschlag MR, Roblin PM. Microbiologic efficacy of levofloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Antimicrob Agents Chemother. 2000 May;44(5):1409.
http://aac.asm.org/cgi/content/full/44/5/1409
http://www.ncbi.nlm.nih.gov/pubmed/10819727?tool=bestpractice.com
[14]Hammerschlag MR, Roblin PM. Microbiologic efficacy of moxifloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Int J Antimicrob Agents. 2000 Jul;15(2):149-52.
http://www.ncbi.nlm.nih.gov/pubmed/10854812?tool=bestpractice.com
[21]Roblin PM, Hammerschlag MR. Microbiologic efficacy of azithro-mycin and susceptibility to azithromycin of isolates of Chlamydia pneumoniae from adults and children with community acquired pneumonia. Antimicrob Agents Chemother. 1998 Jan;42(1):194-6.
http://aac.asm.org/cgi/content/full/42/1/194
http://www.ncbi.nlm.nih.gov/pubmed/9449287?tool=bestpractice.com
[24]Riska PF, Kutlin A, Ajiboye P, et al. Genetic and culture-based approaches for detecting macrolide resistance in Chlamydia pneumoniae. Antimicrob Agents Chemother. 2004 Sep;48(9):3586-90.
http://aac.asm.org/cgi/content/full/48/9/3586
http://www.ncbi.nlm.nih.gov/pubmed/15328134?tool=bestpractice.com
Como a cultura não é realizada rotineiramente no ambiente clínico, não é possível determinar se a persistência é secundária à resistência, ou até mesmo se o organismo ainda está presente. No entanto, a C pneumoniae não parece desenvolver resistência com facilidade in vitro.[24]Riska PF, Kutlin A, Ajiboye P, et al. Genetic and culture-based approaches for detecting macrolide resistance in Chlamydia pneumoniae. Antimicrob Agents Chemother. 2004 Sep;48(9):3586-90.
http://aac.asm.org/cgi/content/full/48/9/3586
http://www.ncbi.nlm.nih.gov/pubmed/15328134?tool=bestpractice.com