Mycoplasma Infections (Mycoplasma pneumoniae) Guidelines

Updated: Dec 13, 2022
  • Author: Ken B Waites, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Clinical Practice Guidelines

M pneumoniae is only one of several bacterial pathogens that cause community-acquired pneumonias (CAP) with overlapping clinical presentations. It is impractical and even impossible to identify a microbiologic etiology in an ambulatory care setting or even a hospital setting when empiric antimicrobial treatment should be begun in a timely manner. Therefore, various professional organizations have published guidelines for diagnosis and management of CAP which are updated at periodic intervals taking into account changes in epidemiology of likely microbial causes and emergence of acquired antimicrobial resistance.

The American Thoracic Society (ATS) has joined with the Infectious Diseases Society of America (IDSA) to publish a guideline for adults, whereas the Pediatric Infectious Diseases Society (PIDSA) has joined with the IDSA to publish guidelines for children. The ATS/IDSA guidelines published in 2019 do not address laboratory testing or specific antimicrobial treatment directed at M pneumoniae, nor do they address the issue of treatment failures due to macrolide resistance. However, these guidlines for CAP, including moderate or severe illness, all incorporate macrolides, doxycycline, and/or fluoroquinolones into their recommendations. These antimicrobial agents should provide adequate coverage for M pneumoniae infections except for some of those that may be due to macrolide-resistance organisms. [20]

The PIDS/IDSA guidelines for CAP in children published in 2011 [21]   recommend testing for M pneumoniae if laboratory results can be available within a clinically relevant timeframe. Note that these guidelines were published prior to the widespread availablity of FDA-cleared automated commercial PCRs to detect M pneumoniae. This guideline recommends primary treatment with a macrolide with levofloxacin as a secondary choice, even though they do not specifically address the issue of clinically significant macrolide resistance in M pneumoniae. Over the past several years, there have been reports of successful treatment of children with macrolide-resistant M pneumoniae infections with levlfloxacin, so this recommendation appears to be justified. [1]