What is Mycoplasma pneumonia?

From the Guidelines

Mycoplasma pneumonia should be treated with a macrolide, such as azithromycin, as the first-line therapy, due to its effectiveness in reducing the length and severity of pneumonia caused by Mycoplasma pneumoniae. The treatment typically involves antibiotics, with azithromycin being commonly prescribed at 500mg on day one, followed by 250mg daily for 4 more days 1.

Key Considerations

• Alternatives to macrolides include doxycycline (100mg twice daily for 7-14 days) for patients who cannot tolerate macrolides or in areas with high macrolide resistance 1.
• Fluoroquinolones like levofloxacin (750mg daily for 5 days) may be used in severe cases or treatment failures, but their use is generally discouraged in outpatient settings due to concerns about resistance 1.
• Supportive care includes rest, adequate hydration, and antipyretics for fever.

Pathophysiology and Epidemiology

• Mycoplasma pneumonia often presents with a gradual onset of symptoms including persistent dry cough, low-grade fever, headache, and fatigue 1.
• The infection spreads through respiratory droplets and is particularly common in crowded settings like schools and military barracks.
• Most cases resolve completely with appropriate treatment, though the cough may persist for several weeks after the infection clears.

Clinical Evidence

• Studies have shown that macrolides are effective in reducing the length and severity of pneumonia caused by Mycoplasma pneumoniae, compared to other antibiotics or no treatment 1.
• Azithromycin has been shown to be slightly more efficacious than other antibiotics, such as ceftibuten, in treating Mycoplasma pneumoniae infections 1.

From the FDA Drug Label

Community-acquired pneumonia due to Chlamydophila pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae or Streptococcus pneumoniae in patients appropriate for oral therapy

• Mycoplasma pneumoniae is listed as one of the microorganisms that azithromycin is indicated for in the treatment of community-acquired pneumonia.
• Azithromycin is effective against Mycoplasma pneumoniae in patients with mild to moderate infections who are appropriate for oral therapy 2.
• It is essential to note that azithromycin should not be used in patients with pneumonia who are judged to be inappropriate for oral therapy due to moderate to severe illness or risk factors.
• Additionally, clarithromycin also has been shown to be active against Mycoplasma pneumoniae [see Indications and Usage (1)] 3.

From the Research

Mycoplasma Pneumonia Overview

• Mycoplasma pneumoniae is a bacterium that causes community-acquired respiratory tract infections, particularly in school-aged children and young adults 4.
• These infections occur both endemically and epidemically worldwide, and M. pneumoniae lacks a cell wall, making it resistant to beta-lactams and antimicrobials targeting the cell wall 4.

Treatment and Resistance

• Macrolides and related antibiotics are the first-line treatment for M. pneumoniae respiratory tract infections due to their low MIC against the bacteria, low toxicity, and absence of contraindication in young children 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.
• Macrolide resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides 4, 5.
• Alternative antibiotic treatments, including tetracyclines and fluoroquinolones, may be required in cases of macrolide resistance 4, 5.

Antibiotic Efficacy

• Azithromycin, clarithromycin, and erythromycin are highly active against M. pneumoniae, with clarithromycin being the most active against Ureaplasma urealyticum and azithromycin being somewhat more active than erythromycin against Mycoplasma hominis 6.
• Roxithromycin, a new macrolide antibiotic, has been shown to be effective in the treatment of mycoplasma pneumonia, with an efficacy rate of 92.3% 7.
• Minocycline and tosufloxacin have been shown to be effective against macrolide-resistant M. pneumoniae, with minocycline shortening the duration of fever in pediatric patients infected with MRMP compared to macrolides 8.

Molecular Detection and Therapeutic Options

• Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens 4.
• Therapeutic options for patients infected with macrolide-resistant M. pneumoniae include tetracyclines, such as doxycycline and minocycline, and fluoroquinolones, primarily levofloxacin, although these may be contraindicated in children 4, 5.