经培养证实的肺炎衣原体呼吸道感染患者,包括社区获得性肺炎,通常对抗生素治疗反应良好,且症状缓解更快速。[10]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;33:983-989.http://cid.oxfordjournals.org/content/33/7/983.longhttp://www.ncbi.nlm.nih.gov/pubmed/11528569?tool=bestpractice.com[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 约 10% 的患者可能需要进行第二个疗程治疗。在疾病急性期后,肺炎衣原体可能在呼吸道中持续存在6 个月,如果未经治疗则时间更长。[17]Hammerschlag MR, Chirgwin K, Roblin PM, et al. Persistent infection with Chlamydia pneumoniae following acute respiratory illness. Clin Infect Dis. 1992;14:178-182.http://www.ncbi.nlm.nih.gov/pubmed/1571425?tool=bestpractice.com[18]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;148:727-732.http://www.ncbi.nlm.nih.gov/pubmed/8019629?tool=bestpractice.com 但是,即使该微生物持续存在,大多数患者仍达到临床缓解。[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[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尚未证明治疗后患者中肺炎衣原体存在对抗生素的真正耐药。来自持续感染患者的分离株的体外药敏试验表明同基线时获得的分离株相比没有任何变化。[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[19]Riska PF, Kutlin A, Ajiboye P, et al. Genetic and culture-based approaches for detecting macrolide resistance in Chlamydia pneumoniae. Antimicrob Agents Chemother. 2004;48:3586-3590.http://aac.asm.org/cgi/content/full/48/9/3586http://www.ncbi.nlm.nih.gov/pubmed/15328134?tool=bestpractice.com 由于培养不是临床环境中的常规操作,因此不能确定持续感染是否继发于耐药,甚至无法确定该微生物是否仍存在。但是, 肺炎衣原体在体外似乎不容易产生耐药。[19]Riska PF, Kutlin A, Ajiboye P, et al. Genetic and culture-based approaches for detecting macrolide resistance in Chlamydia pneumoniae. Antimicrob Agents Chemother. 2004;48:3586-3590.http://aac.asm.org/cgi/content/full/48/9/3586http://www.ncbi.nlm.nih.gov/pubmed/15328134?tool=bestpractice.com