From the Guidelines
Walking pneumonia, also known as atypical or mycoplasma pneumonia, is typically treated with antibiotics, rest, and supportive care, with macrolides like azithromycin (500mg on day 1, then 250mg daily for 4 more days) or clarithromycin (500mg twice daily for 7-14 days) being the most commonly prescribed antibiotics 1. The treatment approach for walking pneumonia is largely based on the patient's overall health and the presence of any underlying conditions.
- For previously healthy individuals with no risk factors for drug-resistant Streptococcus pneumoniae (DRSP) infection, a macrolide such as azithromycin or clarithromycin is recommended as the first-line treatment 1.
- Alternatively, doxycycline may be used, especially for those allergic to macrolides, although it is considered a weaker recommendation due to its lower level of evidence 1.
- For patients with comorbidities or recent antimicrobial therapy, a respiratory fluoroquinolone or combination therapy with a beta-lactam and a macrolide is recommended to cover the possibility of DRSP infection 1. While recovering from walking pneumonia, it's essential to:
- Get plenty of rest
- Stay hydrated
- Take over-the-counter medications like acetaminophen or ibuprofen to manage fever and discomfort Most people can continue normal activities with walking pneumonia, but should avoid strenuous exercise until symptoms improve. Unlike more severe forms of pneumonia, walking pneumonia is caused by different bacteria (often Mycoplasma pneumoniae) that create milder symptoms but can persist for weeks if untreated 1. Even with treatment, the cough may last several weeks after other symptoms resolve. If symptoms worsen despite treatment or if you have underlying health conditions, contact your healthcare provider promptly. It's also important to note that the use of fluoroquinolones to treat ambulatory patients with CAP without comorbid conditions, risk factors for DRSP, or recent antimicrobial use is discouraged due to concerns about the development of fluoroquinolone resistance 1. In contrast, a more recent study from 2011 provides guidelines for the treatment of community-acquired pneumonia in infants and children older than 3 months of age, but the recommendations for adults are based on the 2007 study 1.
From the FDA Drug Label
Treatment of pneumonia 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
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.
The treatment for atypical pneumonia (walking pneumonia) is azithromycin or levofloxacin.
- Azithromycin is effective in the treatment of community-acquired pneumonia due to Chlamydia pneumoniae, Mycoplasma pneumoniae, or Streptococcus pneumoniae.
- Levofloxacin has a clinical success rate of 96% in patients with atypical pneumonia due to Chlamydophila pneumoniae and Mycoplasma pneumoniae 2, 3.
From the Research
Treatment Options for Atypical Pneumonia
The treatment for atypical pneumonia, also known as walking pneumonia, typically involves the use of antibiotics. The choice of antibiotic depends on the causative pathogen and its susceptibility to various antibiotics.
First-Line Treatment
- Macrolides, such as azithromycin and clarithromycin, are commonly used as first-line treatment for atypical pneumonia caused by Mycoplasma pneumoniae 4, 5, 6.
- A 5-day to 14-day course of oral azithromycin or clarithromycin is often recommended for the treatment of community-acquired pneumonia due to M. pneumoniae 4, 5, 6.
Alternative Treatment Options
- In cases of macrolide resistance, alternative antibiotics such as tetracyclines (e.g., doxycycline and minocycline) and fluoroquinolones (e.g., levofloxacin) may be considered 4, 7.
- However, the use of tetracyclines and fluoroquinolones is contraindicated in children and pregnant women due to potential adverse effects 4, 7.
Treatment Duration
- A 3-day to 5-day course of azithromycin has been shown to be effective in treating atypical pneumonia in adult patients 8.
- The treatment duration may vary depending on the severity of the disease and the patient's response to treatment 4, 7.
Considerations for Macrolide Resistance
- Macrolide resistance has been increasing worldwide, and alternative treatment options may be necessary in cases of resistance 4, 7.
- The clinical benefit of alternative antibiotics, such as tetracyclines and fluoroquinolones, has been shown in terms of shortening the duration of symptoms and rapid defervescence in some reports 7.