What are the antibiotic therapy options for the treatment of Mycoplasma infections (Mycoplasma pneumoniae)?

Updated: Feb 15, 2019
  • Author: Ken B Waites, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Oral erythromycin or one of the newer macrolides such as azithromycin or clarithromycin have long been the DOC for mycoplasmal respiratory tract infections. Tetracycline and its analogues are also active. Clindamycin is effective in vitro, but limited reports suggest it may not be active in vivo and thus is not considered a first-line treatment. Fluoroquinolones such as levofloxacin or moxifloxacin exhibit bactericidal antimycoplasmal activity but are generally less potent in vitro than macrolides against M pneumoniae. Their advantage lies in the fact that they are active against all classes of bacteria that produce clinically similar respiratory tract infections, including macrolide-resistant S pneumoniae. As would be predicted by the lack of a cell wall, none of the beta-lactams is effective in vitro or in vivo against M pneumoniae, and neither are the sulfonamides or trimethoprim. [1]

Mycoplasma species are slow-growing organisms that have the capacity to reside intracellularly; thus, respiratory tract infections are expected to respond better to longer treatment courses than might be offered for other types of infections. Although physicians typically prescribe most treatment regimens (ie, both oral and parenteral) for 7-10 days, a 14- to 21-day course of oral therapy with most agents is also appropriate. A 5-day course of oral azithromycin is approved for the treatment of community-acquired M pneumoniae pneumonia. Clinical data indicate that this duration of treatment is of comparable efficacy to a 10-day course of erythromycin. Other drugs, including fluoroquinolones, have been approved for the treatment of mycoplasmal respiratory infections with shorter courses because of their favorable pharmacokinetics and tolerability.


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