Medication Summary

In the treatment of mycoplasmal pneumonia, antimicrobials against M pneumoniae are bacteriostatic, not bactericidal. Tetracycline and erythromycin compounds are very effective. The second-generation tetracyclines (doxycycline) and macrolides are the drugs of choice.^[54]Macrolide resistance has been reported in several areas of the world, but most experts agree that macrolides are the antibiotics of choice for treating M pneumoniae infections in adults and children.^{[55, 56, 57, 58, 59]}If a patient does not respond appropriately to a macrolide, a fluoroquinolone should be added to the treatment regimen.^{[55, 56]}Penicillins and cephalosporins are ineffective, because the organism lacks a cell wall.

Macrolide resistance has been increasing throughout the world, with 0-15% resistance in Europe and the United States, 30% in Israel, and 90-100% in Asia,^[60]but macrolides remain the mainstay of treatment. If symptoms do not resolve, consider prescribing tetracyclines (doxycycline and minocycline) or fluoroquinolones (levofloxacin).^[61]Doxycycline has been avoided in children younger than 8 years because of fear of tooth staining, but the US Centers for Disease Control and Prevention has stated that short courses of newer formulations of doxycycline do not cause tooth staining.^[62]

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Erythromycin (E.E.S., Erythrocin, Ery-Tab)

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Erythromycin is a macrolide antibiotic that is used in the treatment of staphylococcal and streptococcal infections. This agent acts by inhibiting bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes and causing RNA-dependent protein synthesis to arrest.

Azithromycin (Zithromax)

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Azithromycin is a macrolide antibiotic that is very effective against M pneumoniae and may be the most common agent used to treat M pneumoniae given its ease of administration.

Clarithromycin (Biaxin, Biaxin XL)

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Clarithromycin is a macrolide antibiotic that 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, which results in bacterial growth inhibition.

Doxycycline (Vibramycin, Vibra-Tabs)

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Doxycycline is a tetracycline antibiotic that is used to treat susceptible bacterial infections of both gram-positive and gram-negative organisms, as well as infections caused by Mycoplasma, Chlamydophilia, and Rickettsia organisms. This agent is as effective as erythromycin and other macrolides in the treatment of M pneumoniae infection. Doxycycline inhibits bacterial protein synthesis by binding with the 30S subunit and possibly the 50S ribosomal subunit of susceptible bacteria.

Levofloxacin (Levaquin)

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Levofloxacin is a fluoroquinolone antibiotic that can be used to treat Mycoplasma infections. It works by inhibiting the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.

Moxifloxacin (Avelox)

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Moxifloxacin is a fluoroquinolone antibiotic that inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription.

Questions

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