What is the treatment for Mycoplasma (Mycoplasma) infections?

Treatment for Mycoplasma Pneumoniae Infections

Macrolide antibiotics, particularly azithromycin, are the first-line treatment for Mycoplasma pneumoniae infections. 1, 2

First-Line Treatment Options

For Children:

• Preferred oral therapy: Azithromycin 10 mg/kg on day 1, followed by 5 mg/kg/day once daily on days 2-5 1
• Alternatives:
  • Clarithromycin 15 mg/kg/day in 2 doses 1
  • Oral erythromycin 40 mg/kg/day in 4 doses 1
  • For children >7 years old: Doxycycline 2-4 mg/kg/day in 2 doses 1, 3

For Adults:

• Preferred: Azithromycin 500 mg on day 1, then 250 mg daily for 4 days (5-day regimen) 2
• Alternatives:
  • Clarithromycin for 7-10 days 2
  • Doxycycline for 7-10 days 2, 3
  • Respiratory fluoroquinolones (levofloxacin or moxifloxacin) for 5-7 days in cases of macrolide resistance or contraindications 2, 4

Treatment Considerations

Macrolide Resistance

• Macrolide resistance has been increasing worldwide, ranging from 0-15% in Europe and the USA to 90-100% in parts of Asia 5, 6
• In areas with high macrolide resistance, consider:
  1. Monitoring clinical response within 48-72 hours 2
  2. Switching to alternative antibiotics if no improvement is seen

Special Populations

• Hospitalized patients: Consider combination therapy with a beta-lactam plus a macrolide 2
• Severe infections: Intravenous azithromycin 10 mg/kg on days 1 and 2, then transition to oral therapy 1

Clinical Efficacy

• Azithromycin has shown superior efficacy compared to erythromycin in treating Mycoplasma pneumonia in children, with higher cure rates (98% vs. 74.5%) and fewer adverse reactions (15.7% vs. 41.2%) 7
• The 5-day azithromycin regimen may be more effective and less likely to induce resistance compared to the single 1g dose (which is used for other infections) 8

Safety Considerations

• Monitor for QT prolongation with azithromycin, especially in patients with:
  • Known QT interval prolongation
  • History of torsades de pointes
  • Congenital long QT syndrome
  • Uncompensated heart failure
  • Concurrent use of other QT-prolonging medications 9

Treatment Duration

• Standard treatment duration for uncomplicated Mycoplasma pneumoniae infections:
  • 5 days with azithromycin
  • 7-10 days with clarithromycin or doxycycline
  • Extended duration may be needed for more severe cases 2

Supportive Care

• Adequate hydration
• Rest
• Antipyretics for fever management
• Analgesics for pleuritic pain if present 2

Remember that early treatment with azithromycin does not necessarily lead to better outcomes in areas with high macrolide resistance 10. The most important factor is selecting the appropriate antibiotic based on local resistance patterns and monitoring the clinical response.