Antibiotic Treatment and Resistance
Antibiotic treatment
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
- Tetracyclines (e.g., doxycycline): Older children and adults
- Fluoroquinolones: Adults
Clinicians should not prescribe tetracyclines and fluoroquinolones 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.
Antibiotic resistance
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.
- 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 China. 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 children. J Clin Microbiol. 2013;51:723–4.
- Diaz MH, Benitez AJ, Winchell JM. Investigations of Mycoplasma pneumoniae Infections in the United States: Trends in Molecular Typing and Macrolide Resistance from 2006 to 2013. J Clin Microbiol. 2015;53(1):124-130.
- Hicks LA, Taylor TH Jr, Hunkler RD. U.S. outpatient antibiotic prescribing, 2010. 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 patients. 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 Japan. 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 pneumonia. 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 vitro. 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 years. J Clin Microbiol. 2007;45:3534–9.
- Principi N, Esposito S. Macrolide-resistant Mycoplasma pneumoniae: its role in respiratory infection. J Antimicrob Chemother. 2013;68:506–11.
- Rothstein TE, Cunningham SA, Rieke RA, Mainella JM, Mutchler MM, Patel R. Macrolide resistance in Mycoplasma pneumoniae, Midwestern United States, 2014 to 2021. Antimicrob Agents Chemother. 2022;66(4):e0243221.
- Suzuki S, Yamazaki T, Narita M, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother. 2006;50:709–12.
- Waites KB, Ratliff A, Crabb DM, et al. 2019. Macrolide-resistant Mycoplasma pneumoniae in the United States as determined from a national surveillance program. J Clin Microbiol. 2019 57(11):e00968-19.
- Zheng X, Lee S, Selvarangan R, et al. Macrolide-Resistant Mycoplasma pneumoniae, United States. Emerg Infect Dis. 2015;21(8):1470-1472.