抗生素治疗是肺炎衣原体引发的社区获得性肺炎的主要选择。[11]Kohlhoff SA, Hammerschlag MR. Treatment of chlamydial infections: 2014 update.
Expert Opin Pharmacother. 2015;16:205-212.http://www.ncbi.nlm.nih.gov/pubmed/25579069?tool=bestpractice.com
成人
肺炎衣原体对四环素类、大环内酯类和氟喹诺酮类敏感,这些抗生素是同等的一线选择。大多数肺炎衣原体引发的肺炎治疗研究都完全依赖于血清学诊断;因此,无法从这些试验来评估微生物学疗效。零星报道表明,可能需要将四环素类或红霉素的疗程延长至 3 周,以根除流感样疾病和咽炎成人患者鼻咽中的肺炎衣原体。包括左氧氟沙星和莫西沙星在内的氟喹诺酮类在治疗成人肺炎衣原体时非常有效。成人中的微生物治疗:中等质量证据显示,包括左氧氟沙星和莫西沙星在内的喹诺酮类根除了 70% 至 80% 的社区获得性肺炎成人患者中的肺炎嗜衣原体。[12]Hammerschlag MR, Roblin PM. Microbiologic efficacy of levofloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Antimicrob Agents Chemother. 2000;44:1409.http://aac.asm.org/cgi/content/full/44/5/1409http://www.ncbi.nlm.nih.gov/pubmed/10819727?tool=bestpractice.com[13]Hammerschlag MR, Roblin PM. Microbiologic efficacy of moxifloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Int J Antimicrob Agents. 2000;15:149-152.http://www.ncbi.nlm.nih.gov/pubmed/10854812?tool=bestpractice.com受试者<200名的随机对照临床试验(RCT)、受试者>200名且方法学存在缺陷的随机对照临床试验(RCT)、方法学存在缺陷的系统评价或者高质量的观察性(队列)研究。四环素类和喹诺酮类不可用于妊娠女性。此群体应使用大环内酯类(阿奇霉素、克拉霉素或红霉素)进行治疗。
尽管微生物持续存在,但大多数患者的临床症状都会得到改善。[14]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; 14:471-477.http://www.ncbi.nlm.nih.gov/pubmed/7667050?tool=bestpractice.com[15]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;17:865-871.http://www.ncbi.nlm.nih.gov/pubmed/9802626?tool=bestpractice.com[16]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;42:194-196.http://aac.asm.org/cgi/content/full/42/1/194http://www.ncbi.nlm.nih.gov/pubmed/9449287?tool=bestpractice.com[12]Hammerschlag MR, Roblin PM. Microbiologic efficacy of levofloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Antimicrob Agents Chemother. 2000;44:1409.http://aac.asm.org/cgi/content/full/44/5/1409http://www.ncbi.nlm.nih.gov/pubmed/10819727?tool=bestpractice.com 微生物持续存在似乎并非继发于抗生素耐药性的产生。[16]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;42:194-196.http://aac.asm.org/cgi/content/full/42/1/194http://www.ncbi.nlm.nih.gov/pubmed/9449287?tool=bestpractice.com[12]Hammerschlag MR, Roblin PM. Microbiologic efficacy of levofloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Antimicrob Agents Chemother. 2000;44:1409.http://aac.asm.org/cgi/content/full/44/5/1409http://www.ncbi.nlm.nih.gov/pubmed/10819727?tool=bestpractice.com[13]Hammerschlag MR, Roblin PM. Microbiologic efficacy of moxifloxacin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae. Int J Antimicrob Agents. 2000;15:149-152.http://www.ncbi.nlm.nih.gov/pubmed/10854812?tool=bestpractice.com
儿童
建议使用大环内酯类进行治疗。儿童中的微生物治疗:中等质量证据显示,10 天疗程的红霉素和克拉霉素以及 5 天疗程的阿奇霉素干混悬剂具有相同的疗效;它们均根除了 79% 至 86% 儿童中的肺炎衣原体。[14]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; 14:471-477.http://www.ncbi.nlm.nih.gov/pubmed/7667050?tool=bestpractice.com[15]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;17:865-871.http://www.ncbi.nlm.nih.gov/pubmed/9802626?tool=bestpractice.com系统评价或者受试者>200名的随机对照临床试验(RCT)。