eMedicine Specialties > Emergency Medicine > Pulmonary

Pneumonia, Mycoplasma: Treatment & Medication

Author: Michael J Bono, MD, FACEP, Professor of Emergency Medicine, Associate Director of Emergency Medicine Residency Program, Department of Emergency Medicine, Eastern Virginia Medical School
Contributor Information and Disclosures

Updated: Aug 5, 2008

Treatment

Emergency Department Care

Mycoplasmal pneumonia should be considered as a possible etiology in any emergency department patient presenting with 3 weeks of a steadily progressive cough. Patients are usually not critically ill, but seek relief from the persistent, worsening cough. Occasionally, various pulmonary and extrapulmonary complications may occur and may require emergent attention.

Medication

Several antimicrobials are effective in reducing the length of illness due to mycoplasmal pneumonia.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. In the treatment of mycoplasmal pneumonia, antimicrobials against M pneumoniae are bacteriostatic, not bactericidal.


Erythromycin (EES, Erythrocin, E-mycin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes and causing RNA-dependent protein synthesis to arrest; for treatment of staphylococcal and streptococcal infections.

Adult

500 mg PO qid for 7-10 d

Pediatric

7.5-12.5 mg/kg/dose PO qid for 7-10 d

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur


Azithromycin (Zithromax)

Very effective against M pneumoniae. Perhaps the most common agent used to treat M pneumoniae given its ease of administration.

Adult

Day 1: 500 mg PO
Days 2-5: 250 mg/d PO

Pediatric

<6 months: Not established
>6 months: day 1: 10 mg/kg PO once; not to exceed 500 mg/d; days 2-5: 5 mg/kg/d PO; not to exceed 250 mg/d

May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine

Documented hypersensitivity; hepatic impairment; do not administer with pimozide

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized, geriatric, or debilitated patients


Clarithromycin (Biaxin)

Reversibly binds to the P site of the 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating the dissociation of peptidyl tRNA from ribosomes; result is bacterial growth inhibition.

Adult

500 mg PO bid for 7-14 d

Pediatric

<6 months: Not established
>6 months: 7.5 mg/kg/dose PO bid for 10 d

Toxicity increases with coadministration of fluconazole and pimozide; effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, HMG CoA-reductase inhibitors; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both

Documented hypersensitivity; coadministration of pimozide

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies


Doxycycline (Vibramycin)

Treats susceptible bacterial infections of both gram-positive and gram-negative organisms, as well as infections caused by Mycoplasma, Chlamydophilia, and Rickettsia organisms; inhibits bacterial protein synthesis by binding with the 30S subunit and possibly the 50S ribosomal subunit of susceptible bacteria; as effective as erythromycin and other macrolides in the treatment of M pneumoniae infection.

Adult

100 mg PO bid for 1-4 wk

Pediatric

<8 years: Not recommended
>8 years: 2-4 mg/kg/d up to 200 mg/d PO divided bid

Do not give with dairy products or with any divalent cations (eg, Fe++, Ca++, Mg++); can increase hypoprothrombinemic effects of anticoagulants (monitor PT in patients taking both medications); coadministration can decrease the pharmacologic effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider determining drug serum levels in prolonged therapy; doxycycline use during tooth development (last half of gestation through age 8 y) can cause permanent discoloration of teeth; fluids should be liberally consumed to reduce the risk of esophageal irritation and ulceration

More on Pneumonia, Mycoplasma

Overview: Pneumonia, Mycoplasma
Differential Diagnoses & Workup: Pneumonia, Mycoplasma
Treatment & Medication: Pneumonia, Mycoplasma
Follow-up: Pneumonia, Mycoplasma
References
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References

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Further Reading

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Keywords

mycoplasma pneumonia, mycoplasmal pneumonia, Mycoplasma pneumoniae, M pneumoniae, CAP, community-acquired pneumonia, atypical pneumonia, sore chest, tracheal tenderness, dry cough, bullous myringitis, pharyngeal erythema, scratchy sore throat

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Contributor Information and Disclosures

Author

Michael J Bono, MD, FACEP, Professor of Emergency Medicine, Associate Director of Emergency Medicine Residency Program, Department of Emergency Medicine, Eastern Virginia Medical School
Michael J Bono, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Heart Association, Medical Society of Virginia, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone III, MD, EMS Medical Director, Kansas City, Missouri; Associate Professor and Staff Physician, Truman Medical Centers/UMKC School of Medicine
Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Paul Blackburn, DO, FACOEP, FACEP, Program Director, Department of Emergency Medicine, Maricopa Medical Center; Assistant Professor, Department of Surgery, University of Arizona
Paul Blackburn, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Medical Association, and Arizona Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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