What is the treatment for mycoplasma pneumonia?

Treatment of Mycoplasma Pneumonia in Western Massachusetts

Macrolide antibiotics are the first-line treatment for Mycoplasma pneumoniae infections in both adults and children, with azithromycin and clarithromycin being the preferred agents. 1

First-Line Treatment Options

• Azithromycin: 500 mg PO on day 1, then 250 mg PO daily for 4 days (5-day total course) 1, 2
• Clarithromycin: 500 mg PO twice daily for 7-14 days 1, 3
• For severe cases requiring hospitalization, consider combination therapy with a β-lactam plus a macrolide 1

Alternative Treatment Options (for macrolide resistance or treatment failure)

• Doxycycline: 100 mg PO twice daily for 7-14 days 4, 1
• Minocycline: 200 mg PO/IV for first dose, then 100 mg PO/IV twice daily for 7-14 days 4, 1
• Fluoroquinolones (adults only):
  • Levofloxacin: 750 mg PO/IV daily for 7-14 days 4, 1
  • Moxifloxacin: 400 mg PO/IV daily for 7-14 days 4, 1

Clinical Monitoring

• Assess for clinical response based primarily on fever resolution, which typically takes 2-4 days in M. pneumoniae infection 1
• If a patient remains febrile or shows clinical deterioration after 48-72 hours of macrolide therapy, consider:
  • Alternative diagnosis or complications 1
  • Possible macrolide resistance (particularly important as macrolide resistance rates have been increasing) 5, 6
  • Switching to alternative antibiotics (tetracyclines or fluoroquinolones) 1

Special Considerations

Macrolide Resistance

• Macrolide resistance rates vary geographically, ranging from 0-15% in the United States and Europe to 30-100% in parts of Asia 5, 7
• Resistance is associated with point mutations in the 23S rRNA and leads to high-level resistance to macrolides 5
• Children infected with macrolide-resistant M. pneumoniae who receive macrolide treatment may experience persistent fever with extended antibiotic therapy 6

Age-Specific Considerations

• For children under 8 years, macrolides are the only recommended option due to contraindications of tetracyclines and fluoroquinolones 1, 5
• For children 8 years and older and adults with treatment failure, tetracyclines are the preferred second-line agents 1, 6
• Fluoroquinolones should be reserved for adults with contraindications to both macrolides and tetracyclines 1, 5

Safety Warnings

• Azithromycin: Monitor for QT prolongation in at-risk patients, hepatotoxicity, and allergic reactions 2
• Clarithromycin: Adjust dosage in patients with renal impairment (reduce by 50% if CrCl <30 mL/min) 3
• All antibiotics: Monitor for Clostridium difficile-associated diarrhea 2

Outbreak Management

• In institutional outbreaks, azithromycin prophylaxis (500 mg on day 1,250 mg/day on days 2-5) plus standard epidemic-control measures has been shown to reduce secondary attack rates 8

By following this treatment algorithm for M. pneumoniae infections, clinicians can effectively manage patients while considering important factors such as age, comorbidities, and local resistance patterns.