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.

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, 10, 71]}

Ketolides show effective activity against mycoplasmal organisms. Telithromycin 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.

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, 10]}

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

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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.

Clarithromycin (Biaxin)

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

Azithromycin (Zithromax)

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

Tetracycline (Sumycin)

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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.

Doxycycline (Vibramycin)

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

Levofloxacin (Levaquin)

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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.

Telithromycin (Ketec)

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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).

Follow-up

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Media Gallery

General characteristics of Mycoplasma species.

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Author

Archana Chatterjee, MD, PhD Professor and Chair, Department of Pediatrics, Senior Associate Dean for Faculty Development, Sanford School of Medicine, The University of South Dakota

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

Disclosure: Nothing to disclose.

Coauthor(s)

Catherine OKeefe, DNP, APRN-NP Associate Professor of Nursing, Clinician-Educator Track Graduate Curriculum Coordinator, Nurse Practitioner Programs, Creighton University, School of Nursing; Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine OKeefe, DNP, APRN-NP is a member of the following medical societies: American Association of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD, FACP Editor-in-Chief, ID Cases; Moderator, Program for Monitoring Emerging Diseases; Adjunct Professor of Medicine, State University of New York Downstate College of Medicine

Larry I Lutwick, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American Association for the Study of Liver Diseases, American College of Physicians, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, Infectious Diseases Society of New York, International Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs Society of Practitioners in Infectious Diseases

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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.