Chlamydia pneumoniae

C. pneumoniae is susceptible to many antimicrobials in vitro, i.e. tetracycline, macrolides, and fluoroquinolones. The lowest minimum inhibitory concentrations are obtained with tetracycline, doxycycline, erythromycin, roxythromycin, and particularly clarithromycin and azithromycin which have excellent tissue and intracellular penetration. However, the results of in vitro tests are not good predictors of microbiological efficacy in vivo.

There are few data describing the response of C. pneumoniae to antibiotic treatment. In the first report, 1 g of erythromycin daily failed in most patients. Therefore the initial recommendation for treatment of C. pneumoniae pneumonia was 2 g of tetracycline daily for 7 to 10 days or 1 g daily for 21 days. The first-choice treatment remains doxycycline. However, persistence of C. pneumoniae positive culture after 2-week courses of erythromycin or 30-day courses of tetracycline or doxycycline have been reported. Pharmacokinetics and in vitro activity suggest that clarithromycin and azithromycin are the treatment of choice of C. pneumoniae infection; however the number of subjects in the studies reported are too small to reveal significant differences between antibiotic regimens.

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