Antibiotic Treatment and Resistance
Most M. pneumoniae infections are self-limiting; however, clinicians routinely treat pneumonia caused by Mycoplasma 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 2000. 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 is probably rising in the United States. The increased use of azithromycin in recent years to treat a number of illnesses could help explain this rise.
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.
- Cao B, Zhao CJ, Yin YD, et al. High prevalence of macrolide resistance in Mycoplasma pneumoniae isolates from adult and adolescent patients with respiratory tract infection in ChinaExternal. Clin Infect Dis. 2010;51:189–94.
- Cardinale F, Chironna M, Chinellato I, Principi N, Esposito S. Clinical relevance of Mycoplasma pneumoniae macrolide resistance in childrenExternal. J Clin Microbiol. 2013;51:723–4.
- Hicks LA, Taylor TH Jr, Hunkler RD. U.S. outpatient antibiotic prescribing, 2010External. N Engl J Med. 2013;368:1461–2.
- Matsubara K, Morozumi M, Okada T, et al. A comparative clinical study of macrolide-sensitive and macrolide-resistant Mycoplasma pneumoniae infections in pediatric patientsExternal. J Infect Chemother. 2009;15:380–3.
- Matsuoka M, Narita M, Okazaki N, et al. Characterization and molecular analysis of macrolide-resistant Mycoplasma pneumoniae clinical isolates obtained in JapanExternal. Antimicrob Agents Chemother. 2004;48:4624–30.
- Morozumi M, Iwata S, Hasegawa K, et al. Increased macrolide resistance of Mycoplasma pneumoniae in pediatric patients with community-acquired pneumoniaExternal. Antimicrob Agents Chemother. 2008;52:348–50.
- Okazaki N, Narita M, Yamada S, et al. Characteristics of macrolide-resistant Mycoplasma pneumoniae strains isolated from patients and induced with erythromycin in vitroExternal. Microbiol Immunol. 2001;45:617–20.
- Pereyre S, Charron A, Renaudin H, et al. First report of macrolide-resistant strains and description of a novel nucleotide sequence variation in the P1 adhesin gene in Mycoplasma pneumoniae clinical strains isolated in France over 12 yearsExternal. J Clin Microbiol. 2007;45:3534–9.
- Principi N, Esposito S. Macrolide-resistant Mycoplasma pneumoniae: its role in respiratory infectionExternal. J Antimicrob Chemother. 2013;68:506–11.
- Suzuki S, Yamazaki T, Narita M, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniaeExternal. Antimicrob Agents Chemother. 2006;50:709–12.