From the Guidelines
Mycoplasma is a genus of small bacteria that lack a cell wall, making them naturally resistant to many common antibiotics like penicillins that target cell wall synthesis. The most clinically significant species is Mycoplasma pneumoniae, which causes atypical pneumonia often called "walking pneumonia."
Key Characteristics of Mycoplasma
- Lack a cell wall, making them resistant to beta-lactam antibiotics
- Most clinically significant species is Mycoplasma pneumoniae
- Causes atypical pneumonia, also known as "walking pneumonia"
Treatment of Mycoplasma Infections
- Macrolide antibiotics like azithromycin (500mg on day 1, then 250mg daily for 4 more days) are the first-line treatment 1
- Alternatively, doxycycline (100mg twice daily for 7-14 days) or fluoroquinolones like levofloxacin (750mg daily for 5 days) can be used, especially in areas with high macrolide resistance
Symptoms and Transmission
- Symptoms typically include persistent dry cough, low-grade fever, headache, and fatigue that develop gradually over several days
- Mycoplasma infections are highly contagious through respiratory droplets, with incubation periods of 2-3 weeks
- The slow-growing nature of these organisms explains why symptoms persist longer than typical bacterial infections
Recovery and Adjunctive Treatment
- Complete recovery may take 4-6 weeks even with appropriate treatment
- Rest, adequate hydration, and symptomatic treatment are important adjuncts to antibiotic therapy It's worth noting that the emergence of macrolide resistance has been reported mainly in Asia, with prevalence increasing up to 30.6% in some studies 1. Therefore, it's essential to consider the local resistance patterns when selecting an antibiotic for treatment.
From the Research
Characteristics of Mycoplasma
- Mycoplasmas are the smallest free-living microorganisms, being about 300 nm in diameter 2
- They are bounded by a triple-layered membrane and, unlike conventional bacteria, do not have a rigid cell wall 2
- Due to the lack of a cell wall, mycoplasmas are intrinsically resistant to β-lactams and to all antimicrobials that target the cell wall 3, 4
Antibiotic Susceptibility
- Mycoplasmas are susceptible to a variety of broad-spectrum antibiotics, including tetracyclines, macrolides, and fluoroquinolones 2, 3, 4
- Macrolides and related antibiotics are the first-line treatment for respiratory infections caused by Mycoplasma pneumoniae 3, 4
- Azithromycin is the preferred treatment for Mycoplasma genitalium infection 5, 6
Resistance to Antibiotics
- Mycoplasmas may develop resistance to antibiotics, either by gene mutation or by acquisition of a resistance gene 2
- Resistance to tetracyclines is common in mycoplasmas and is due to acquisition of the tetM gene 2
- Macrolide resistance has been spreading worldwide, with prevalence ranging from 0 to 100% in different regions 3, 4, 5
- Macrolide resistance-associated mutations can be detected using molecular methods, and are associated with point mutations in the 23S rRNA gene 3, 4, 5