Please check your internet connection and try again.
# Mycoplasma (Pathogen, Not a Drug)
## Overview
*Mycoplasma* is a genus of bacteria that lack a cell wall. Several species can cause human disease, most commonly *Mycoplasma pneumoniae*, which is a significant cause of community-acquired pneumonia.
## Primary Indications
Treatment is indicated for *Mycoplasma* infections, predominantly pneumonia. Other extra-pulmonary manifestations may also require treatment.
## Adult Dosing
Treatment recommendations vary. Common antibiotic choices include:
* **Azithromycin:** 500 mg orally on day 1, then 250 mg orally once daily for 4 more days.
* **Doxycycline:** 100 mg orally twice daily for 7-14 days.
* **Levofloxacin:** 750 mg orally once daily for 5 days.
Specific duration and choice of agent may depend on clinical presentation, local resistance patterns, and patient factors.
## Pediatric Dosing
Dosing for pediatric patients depends on the specific antimicrobial agent and the child's age and weight.
* **Azithromycin:**
* Children 6 months to 5 years: 10 mg/kg orally on day 1 (maximum 500 mg), then 5 mg/kg orally once daily for 4 more days (maximum 250 mg/day).
* Children > 5 years: 500 mg orally on day 1 (maximum 500 mg), then 250 mg orally once daily for 4 more days (maximum 250 mg/day).
* **Doxycycline:** Typically not recommended in children < 8 years due to tooth discoloration concerns, unless other options are not viable. For children ≥ 8 years: 2-4 mg/kg/day orally divided into two doses (maximum 100 mg twice daily) for 7-14 days.
* **Levofloxacin:** Generally reserved for severe or resistant infections in pediatrics. Consult specific pediatric guidelines.
## Dose Adjustments
No dose adjustment is typically required for renal or hepatic impairment for azithromycin or doxycycline. Levofloxacin dose adjustments may be needed in severe renal impairment; consult specific guidelines.
## Contraindications
Contraindications are specific to the chosen antimicrobial agent. For example, macrolide (e.g., azithromycin) hypersensitivity is a contraindication. Doxycycline is generally avoided in pregnancy and in children < 8 years.
## Adverse Effects
Adverse effects vary by antibiotic class:
* **Macrolides (Azithromycin):** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), QT prolongation, *Clostridioides difficile*-associated diarrhea.
* **Tetracyclines (Doxycycline):** Photosensitivity, gastrointestinal upset, tooth discoloration (in children < 8 years), *Clostridioides difficile*-associated diarrhea.
* **Fluoroquinolones (Levofloxacin):** Tendon rupture/tendinitis, peripheral neuropathy, *C. difficile*-associated diarrhea, QT prolongation, CNS effects.
## Key Drug Interactions
Interactions depend on the chosen antibiotic.
* **Azithromycin:** May increase levels of cyclosporine. Potential for additive QT prolongation with other QT-prolonging agents.
* **Doxycycline:** Antacids, iron supplements, sucralfate, and dairy products can decrease absorption. May decrease the efficacy of oral contraceptives.
* **Levofloxacin:** Antacids, iron, zinc, sucralfate, multivitamins decrease absorption. May increase the risk of seizure with NSAIDs and theophylline. Potential for additive QT prolongation.
## Monitoring
* Monitor for clinical improvement (resolution of fever, cough, respiratory symptoms).
* Monitor for adverse effects specific to the chosen antibiotic.
* Assess for signs of *Clostridioides difficile*-associated diarrhea.
## Clinical Pearls
* *Mycoplasma pneumoniae* is a common cause of atypical pneumonia, particularly in school-aged children and young adults.
* Symptoms may include headache, malaise, low-grade fever, and a persistent dry cough.
* Treatment duration is typically 7-14 days, though shorter courses of azithromycin are common.
* Due to lack of cell wall, beta-lactam antibiotics (penicillins, cephalosporins) are not effective against *Mycoplasma*.
***
**Disclaimer:** *This information is intended for clinical professionals and is not a substitute for professional medical advice. Always verify current prescribing information, drug interactions, and patient-specific factors before making treatment decisions.*
