From the Guidelines
Mycoplasma infections are typically treated with antibiotics from the macrolide class, with azithromycin being the preferred treatment for most adults and children. For most adults with mycoplasma pneumonia, azithromycin (500mg on day 1, then 250mg daily for 4 more days) is the preferred treatment, as it has been shown to be effective in treating mycoplasma pneumonia 1. For children, azithromycin (10mg/kg on day 1, then 5mg/kg for 4 more days) is commonly used, as it is effective and well-tolerated 1.
Key Considerations
- Alternative options include clarithromycin, levofloxacin, or moxifloxacin, particularly for patients with allergies or in cases of suspected resistance 1.
- Treatment duration typically ranges from 5-14 days depending on the antibiotic chosen and severity of infection.
- Mycoplasma bacteria lack cell walls, making them naturally resistant to beta-lactam antibiotics like penicillins and cephalosporins.
- Patients should complete the full course of antibiotics even if symptoms improve quickly, stay hydrated, rest adequately, and use over-the-counter medications for symptom relief as needed.
Special Considerations
- In areas with high macrolide resistance, such as Asia, alternative antibiotics like tetracyclines or fluoroquinolones may be considered 1.
- For children under 8 years old, short-course doxycycline treatment may be considered as an alternative to macrolides, as it has been shown to be safe and effective without causing enamel staining 1.
From the FDA Drug Label
Treatment: Doxycycline is indicated for the treatment of the following infections: ... Respiratory tract infections caused by Mycoplasma pneumoniae. Safety and effectiveness for pneumonia due to ... Mycoplasma pneumoniae were documented in pediatric clinical trials
- Doxycycline and azithromycin are indicated for the treatment of Mycoplasma pneumoniae infections.
- Doxycycline is indicated for the treatment of respiratory tract infections caused by Mycoplasma pneumoniae 2.
- Azithromycin has been shown to be safe and effective in the treatment of community-acquired pneumonia due to Mycoplasma pneumoniae 3 and 3.
From the Research
Treatment Options for Mycoplasma
- Macrolides and related antibiotics are the first-line treatment for Mycoplasma pneumoniae respiratory tract infections due to their low MIC against the bacteria, low toxicity, and absence of contraindication in young children 4.
- The newer macrolides, such as azithromycin and clarithromycin, are preferred agents with a 7-to-14 day course of oral treatment for community-acquired pneumonia due to M. pneumoniae 4.
- However, macrolide resistance has been spreading worldwide, with prevalence ranging from 0 to 15% in Europe and the USA, approximately 30% in Israel, and up to 90-100% in Asia 4, 5.
- Alternative antibiotic treatments, including tetracyclines such as doxycycline and minocycline, or fluoroquinolones like levofloxacin, may be required in cases of macrolide resistance 4, 6.
- Minocycline and tosufloxacin have shown good in vitro activities against macrolide-resistant M. pneumoniae, and minocycline has been found to shorten the duration of fever in pediatric patients infected with macrolide-resistant M. pneumoniae 6.
Efficacy of Different Treatment Regimens
- A study comparing the therapeutic effects of azithromycin, clarithromycin, minocycline, and tosufloxacin against macrolide-resistant and macrolide-sensitive M. pneumoniae pneumonia in pediatric patients found that minocycline shortened the duration of fever in patients infected with macrolide-resistant M. pneumoniae 6.
- Another study found that switching to doxycycline after 72 hours of initial macrolide therapy was more effective than prolonged azithromycin in treating macrolide-unresponsive M. pneumoniae pneumonia in children 7.
- A meta-analysis of M. genitalium treatment studies using azithromycin found that the 5-day regimen was more effective and less likely to cause resistance than the single-dose regimen 8.