What is the treatment for Mycoplasma symptoms?

Treatment for Mycoplasma Pneumonia

Azithromycin is the first-line treatment for Mycoplasma pneumoniae infections, with a recommended dosage of 500 mg on day 1 followed by 250 mg daily for 4 days. 1

First-Line Treatment Options

Oral Therapy

• Preferred: Azithromycin (10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5) 2
• Alternatives:
  • Clarithromycin (15 mg/kg/day in 2 doses)
  • Oral erythromycin (40 mg/kg/day in 4 doses)
  • For children >7 years old: Doxycycline (2-4 mg/kg/day in 2 doses)
  • For adolescents with skeletal maturity: Levofloxacin (500 mg once daily) or moxifloxacin (400 mg once daily)

Parenteral Therapy (for severe cases)

• Preferred: Intravenous azithromycin (10 mg/kg on days 1 and 2 of therapy; transition to oral therapy when possible) 2
• Alternatives:
  • Intravenous erythromycin lactobionate (20 mg/kg/day every 6 hours)
  • Levofloxacin (16-20 mg/kg/day every 12 hours; maximum daily dose, 750 mg)

Treatment Duration

• Standard treatment duration for uncomplicated Mycoplasma pneumonia is 5 days with azithromycin 1
• For more severe cases, treatment may be extended to 7-10 days 1
• Patients should be transitioned from intravenous to oral therapy when they show clinical improvement and have been afebrile for 24 hours 1

Special Considerations

Age-Specific Recommendations

• Children: Azithromycin is preferred due to better compliance with once-daily dosing and shorter treatment duration 2, 1
• Adults: Azithromycin 500 mg on day 1, then 250 mg daily for 4 days 1

Cautions and Contraindications

• QT prolongation risk: Avoid azithromycin in patients with:
  • Known QT prolongation
  • History of torsades de pointes
  • Congenital long QT syndrome
  • Uncompensated heart failure
  • Concurrent use of other QT-prolonging medications 3
• Hepatotoxicity: Discontinue azithromycin immediately if signs of hepatitis occur 3
• Allergic reactions: Serious allergic reactions including angioedema, anaphylaxis, Stevens-Johnson Syndrome, and toxic epidermal necrolysis have been reported rarely 3

Antibiotic Resistance Considerations

• Macrolide resistance in Mycoplasma pneumoniae has been increasing worldwide, particularly in Asia 4
• If treatment failure occurs with macrolides, consider switching to:
  • Doxycycline (for patients >7 years) 5
  • Respiratory fluoroquinolones (levofloxacin or moxifloxacin) for adults 6

Treatment Algorithm

1. Assess severity:

   • Mild to moderate symptoms (outpatient): Start with oral azithromycin
   • Severe symptoms or inability to take oral medications (inpatient): Start with IV azithromycin

2. Initial treatment:

   • Begin azithromycin (dosing as above)
   • Monitor for clinical improvement within 48-72 hours

3. If no improvement after 48-72 hours:

   • Consider alternative diagnosis
   • Consider antibiotic resistance
   • Switch to alternative antibiotic (doxycycline or fluoroquinolone)

4. Duration:

   • Complete 5-day course for azithromycin
   • Complete 7-10 days for other antibiotics

Common Pitfalls

• Inappropriate antibiotic selection: Using beta-lactams (penicillins, cephalosporins) which are ineffective against Mycoplasma due to lack of cell wall 1
• Inadequate duration: Not completing the full course of antibiotics
• Missing resistance: Failing to consider macrolide resistance in patients not responding to initial therapy
• QT prolongation: Not screening for risk factors before prescribing azithromycin

Remember that Mycoplasma pneumoniae lacks a cell wall, making it intrinsically resistant to beta-lactam antibiotics, which is why macrolides, tetracyclines, or fluoroquinolones must be used 7.