In addition to antibiotics, which medications are used in 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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In addition to the administration of antimicrobials for the management of M pneumoniae infections, other measures (eg, cough suppressants, antipyretics, analgesics) should be administered as needed to relieve headaches and other systemic symptoms. Because extrapulmonary manifestations are often diagnosed late in the course of disease, the benefit of early treatment is unknown.

Since 2000, macrolide-resistant M pneumoniae caused by point mutations in domain V of 23S ribosomal RNA has emerged in Asia and has now been reported in Europe and North America. Recent surveillance conducted primarily in pediatric populations has documented resistance rates of 46%-93% in Japan, 69%-97% in China, 12.3%-23% in Taiwan, 61.3% in South Korea, 30% in Israel, 9.8% in France, and 8.2% in the United States.

Macrolide resistance has also been documented in adults, but to a lesser extent. Selection of resistance during macrolide therapy has been documented in children in France, Italy, and Israel.

While there are no apparent differences in initial presentation to distinguish a patient with macrolide-resistant M pneumoniae, when such infections occur, they are often clinically significant, resulting in prolonged fever, coughing, longer hospital stays, or worsening findings on chest radiographs compared with persons with infections caused by susceptible strains. [18, 19, 20, 21]

The spread of macrolide resistance has led to development of real-time PCR-based assays to detect resistance genes directly in clinical specimens since cultures and conventional susceptibility tests require many more time. [21, 19, 20] In view of the increasing spread of macrolide resistance, clinicians are advised to monitor patient outcomes and to consider using alternative antimicrobial agents (eg, minocycline, doxycycline, tigecycline, fluoroquinolones) if an initial treatment with a macrolide is unsuccessful. [22]

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