Pediatric Mycoplasma Infections Medication

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 28, 2010
 

Medication Summary

As a result of the lack of a cell wall, beta-lactams are ineffective; neither is the combined therapy of trimethoprim and sulfamethoxazole effective. Aminoglycosides are effective in vitro, but efficacy is unknown in vivo.

Ketolides are in development and show effective activity against mycoplasmal organisms. Telithromycin, a recently-licensed ketolide, has been shown to be active against M pneumoniae. It is approved for treatment of community-acquired pneumonia. Because of the risk of hepatotoxicity associated with telithromycin, the US Food and Drug Administration (FDA) removed previously approved indications for sinusitis and acute bacterial exacerbations of chronic bronchitis.

Streptogramins (ie, quinupristin-dalfopristin) are available only as a parenteral formulation; therefore, they are not practical for use in patients with Mycoplasma diseases.

Macrolides are the agents of choice. Alternatively, tetracyclines may be used in patients older than 8 years. Fluoroquinolones may be considered if macrolides or tetracyclines are not suitable choices; however, most fluoroquinolones are not approved by the FDA for use in patients younger than 18 years.[2, 3, 8, 60]

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Because of reports of macrolide resistance, whenever feasible, guide antibiotic selection using culture sensitivity.[2, 3, 8]

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Erythromycin (E.E.S., E-Mycin, Eryc)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer RNA (tRNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections. In children, age, weight, and severity of infection determine proper dosage.

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Clarithromycin (Biaxin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis.

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Azithromycin (Zithromax)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis.

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Tetracycline (Sumycin)

 

Treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits.

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Doxycycline (Vibramycin)

 

Inhibits protein synthesis and thus bacterial growth by binding to 30S and, possibly, 50S ribosomal subunits of susceptible bacteria.

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Levofloxacin (Levaquin)

 

Of the fluoroquinolones (eg, ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin, grepafloxacin), drug of choice (DOC) to treat community-acquired pneumonia in adults. Use in children and pregnant women restricted because of concern regarding cartilage toxicity, but several clinical trials ongoing, and such use may be indicated in the future.

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Telithromycin (Ketec)

 

First antibiotic in new ketolides class. Combats resistant bacteria by inhibiting protein synthesis necessary for bacterial reproduction, binding 10 times tighter than macrolides at 2 sites on bacterial ribosomes. Blocks protein synthesis by binding to 50S ribosomal subunit (23S rRNA at domains II and V). Binding at domain II retains activity against gram-positive cocci (eg, Streptococcus pneumoniae), eliminating resistance mediated by methylases (erm genes) that alter domain V binding site. May also inhibit the assembly of nascent ribosomal units. Resistance and cross resistance have not been observed.

Active against S pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis; as well as atypical bacteria such as Chlamydia pneumoniae, M pneumoniae, and Legionella pneumoniae. Indicated to treat mild-to-moderate community-acquired pneumonia, including infections caused by multidrug resistant S pneumoniae).

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Contributor Information and Disclosures
Author

Archana Chatterjee, MD, PhD  Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine O'Keefe, DNP, APRN  Assistant Professor of Nursing and Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O'Keefe, DNP, APRN is a member of the following medical societies: American Academy of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, and Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Specialty Editor Board

Rosemary Johann-Liang, MD  Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Larry I Lutwick, MD  Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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