What is the role of drug treatment for mycoplasmal pneumonia?

Updated: Dec 28, 2018
  • Author: Michael Joseph Bono, MD, FACEP; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

In the treatment of mycoplasmal pneumonia, antimicrobials against M pneumoniae are bacteriostatic, not bactericidal. Tetracycline and erythromycin compounds are very effective. The second-generation tetracyclines (doxycycline) and macrolides are the drugs of choice. [52] Macrolide resistance has been reported in several areas of the world, but most experts agree that macrolides are the antibiotics of choice for treating M pneumoniae infections in adults and children. [53, 54, 55, 56, 57] If a patient does not respond appropriately to a macrolide, a fluoroquinolone should be added to the treatment regimen. [53, 54] Penicillins and cephalosporins are ineffective, because the organism lacks a cell wall.

Macrolide resistance has been increasing throughout the world, with 0-15% resistance in Europe and the United States, 30% in Israel, and 90-100% in Asia, [58] but macrolides remain the mainstay of treatment. If symptoms do not resolve, consider prescribing tetracyclines (doxycycline and minocycline) or fluoroquinolones (levofloxacin). [59] Doxycycline has been avoided in children younger than 8 years because of fear of tooth staining, but the US Centers for Disease Control and Prevention has stated that short courses of newer formulations of doxycycline do not cause tooth staining. [60]


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