Antibiotic Treatment and Resistance
Most Mycoplasma pneumoniae infections are self-limiting; however, clinicians routinely treat pneumonia caused by M. pneumoniae with antibiotics. All mycoplasmas lack a cell wall and, therefore, all are inherently resistant to beta-lactam antibiotics (e.g., penicillin).
Clinicians treat the disease with macrolide, tetracycline, or fluoroquinolone classes of antibiotics, taking age of the patient and local antibiotic resistance patterns into consideration:
- Macrolides (e.g., azithromycin): Children and adults
- Fluoroquinolones: Adults
- Tetracyclines (e.g., doxycycline): Older children and adults
Clinicians should not prescribe fluoroquinolones and tetracyclines for young children under normal circumstances. Macrolides are generally considered the treatment of choice. However, clinicians should practice prudent use of macrolide drugs due to the emergence of macrolide-resistant strains of M. pneumoniae.
Resistance to macrolides has been emerging in M. pneumoniae since the 2000s. This issue is especially troubling in Asia, where resistance rates have been as high as 90%. The United States and Europe have also reported macrolide resistance. Current data suggest that the prevalence of macrolide resistance in M. pneumoniae may be around 10% in the United States, with regional variability.
Studies have reported that patients with infections due to macrolide-resistant strains may have fever and cough for a longer duration than patients infected with macrolide-sensitive strains.
Experts need to learn more about the extent of macrolide resistance and its clinical implications to inform prescribing decisions.
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