What is the treatment for atypical pneumonia (walking pneumonia)?

From the Guidelines

Walking pneumonia, also known as atypical pneumonia, is typically treated with antibiotics, with azithromycin being the preferred treatment due to its efficacy and safety profile, as reported in the most recent study 1. The most common treatment for walking pneumonia is a macrolide antibiotic such as azithromycin (500mg on day 1, then 250mg daily for 4 more days) or clarithromycin (500mg twice daily for 7-14 days).

• For patients allergic to macrolides, doxycycline (100mg twice daily for 7-14 days) or a fluoroquinolone like levofloxacin (750mg once daily for 5 days) may be prescribed, as suggested by 1.
• Rest is essential during recovery, and staying well-hydrated helps loosen mucus in the lungs.
• Over-the-counter medications like acetaminophen or ibuprofen can help manage fever and discomfort. Some key points to consider when treating walking pneumonia include:
• The bacteria that cause walking pneumonia, such as Mycoplasma pneumoniae, lack cell walls, making certain antibiotics like penicillins ineffective 1.
• Macrolides, such as azithromycin, are the preferred treatment because they work by inhibiting bacterial protein synthesis rather than attacking cell walls.
• Most patients improve within a week of starting antibiotics, though a lingering cough may persist for several weeks. It's worth noting that increased macrolide resistance has been reported in some areas, especially in Asia, as mentioned in 1, which may affect treatment outcomes. In terms of specific treatment guidelines, the study 1 recommends the use of macrolides, tetracyclines, or fluoroquinolones for the treatment of M. pneumoniae infections.
• Azithromycin, levofloxacin, and moxifloxacin have been shown to be effective in treating community-acquired pneumonia, including those caused by M. pneumoniae, as reported in 1.

From the FDA Drug Label

In the treatment of pneumonia, azithromycin has only been shown to be safe and effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy Azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy because of moderate to severe illness or risk factors such as any of the following: patients with cystic fibrosis, patients with nosocomially acquired infections, patients with known or suspected bacteremia, patients requiring hospitalization, elderly or debilitated patients, or patients with significant underlying health problems that may compromise their ability to respond to their illness (including immunodeficiency or functional asplenia) Clinical success rates (cure plus improvement) in the clinically evaluable population were 90.9% in the levofloxacin 750 mg group and 91.1% in the levofloxacin 500 mg group For both studies, the clinical success rate in patients with atypical pneumonia due to Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila were 96%, 96%, and 70%, respectively

Treatment for walking pneumonia (also known as atypical pneumonia) may include:

• Azithromycin 2: effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae
• Levofloxacin 3: effective in the treatment of community-acquired pneumonia, including atypical pneumonia due to Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila Key considerations:
• Patient suitability for oral therapy
• Presence of underlying health problems or risk factors
• Potential for drug interactions or side effects, such as QT prolongation with azithromycin 2

From the Research

Treatment Options for Walking Pneumonia

• Walking pneumonia, also known as atypical pneumonia, can be caused by various organisms such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella species 4, 5.
• The treatment of choice for atypical pneumonia is erythromycin or tetracyclines, with dosages of 2-4 g daily for erythromycin and 200 mg daily for doxycycline 4.
• New macrolide antibiotics have shown promise in treating pneumonia due to M. pneumoniae, L. pneumophila, and C. pneumoniae, with improved pharmacological properties and high tissue and intracellular concentrations 4.
• Azithromycin has been shown to be effective in treating atypical pneumonia, with a 3-day or 5-day course being equally effective 6.

Antibiotic Selection

• The selection of antibiotics for walking pneumonia depends on the suspected or confirmed pathogen, with beta-lactam antibiotics being effective against typical bacterial pathogens and macrolides or tetracyclines being effective against atypical pathogens 5.
• In cases where the pathogen is unknown, a combination of beta-lactam and macrolide or tetracycline, or monotherapy with a fluoroquinolone, may be considered to cover both bacterial and atypical pneumonia 5, 7.
• The Japanese pneumonia guidelines recommend a differential diagnosis for typical bacterial pneumonia and atypical pneumonia to select an appropriate antibiotic, with six parameters and criteria based on clinical symptoms, physical signs, and laboratory data 5.

Treatment Duration and Outcomes

• The duration of treatment for walking pneumonia can vary, with a 3-day or 5-day course of azithromycin being effective in some cases 6.
• The outcomes of treatment for walking pneumonia, including 30-day readmission and 30-day all-cause mortality, have been shown to be similar between narrow and broad oral antibiotic groups in some studies 8.
• However, more research is needed to confirm these findings and to determine the optimal treatment duration and outcomes for walking pneumonia 8, 7.