Infecção por Chlamydia pneumoniae

Os dados sobre a eficácia microbiológica baseados em cultura são limitados; os resultados de três publicações de estudos de tratamento em adultos que usaram culturas demonstraram 70% a 80% de erradicação de Chlamydia pneumoniae do trato respiratório em adultos com pneumonia adquirida na comunidade após o tratamento com azitromicina, levofloxacino ou moxifloxacino.[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 Esses três medicamentos parecem ser equivalentes e podem ser considerados de primeira linha.

Tetraciclinas, especialmente a doxiciclina, também são usadas como primeira linha.

Tetraciclinas e fluoroquinolonas não podem ser usadas em gestantes. O tratamento neste grupo deve usar um macrolídeo (azitromicina, claritromicina ou eritromicina).

As fluoroquinolonas estão associadas a efeitos adversos graves, incapacitantes e potencialmente irreversíveis, incluindo tendinite, ruptura de tendão, artralgia, neuropatias e outros efeitos sobre os sistemas musculoesquelético ou nervoso.[15]European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. Mar 2019 [internet publication]. https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products [16]Food and Drug Administration. FDA Drug Safety Communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. Mar 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics A Food and Drug Administration (FDA) também emitiu avisos sobre o aumento do risco de dissecção de aorta, hipoglicemia significativa e efeitos adversos para a saúde mental em pacientes que tomam fluoroquinolonas.[17]Food and Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Dec 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics [18]Food and Drug Administration. FDA Drug Safety Communication: FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication] https://www.fda.gov/drugs/drug-safety-and-availability/fda-reinforces-safety-information-about-serious-low-blood-sugar-levels-and-mental-health-side

O tratamento é feito com um ciclo de 10 dias de eritromicina ou claritromicina, ou um ciclo de 5 dias de azitromicina em suspensão.[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

Todos esses esquemas demonstraram eficácia de 80% na erradicação do Chlamydia pneumoniae do trato respiratório de crianças.