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# Mycoplasma (pathogen, not a drug)
## Overview
*Mycoplasma* is a genus of bacteria that lack a cell wall. This characteristic makes them intrinsically resistant to beta-lactam antibiotics such as penicillins and cephalosporins. They are common causes of respiratory and urogenital infections.
## Primary Indications
*Mycoplasma* species are identified as pathogens, not treated with a specific "drug" in the context of the query. Treatment is directed at the *Mycoplasma* infection caused by these organisms. Common species causing human disease include *Mycoplasma pneumoniae* (respiratory infections) and *Mycoplasma genitalium* (urogenital infections).
## Adult Dosing
Treatment for *Mycoplasma* infections typically involves antibiotics such as macrolides, tetracyclines, or fluoroquinolones. Specific dosing depends on the *Mycoplasma* species, the site of infection, and the chosen antibiotic.
* **Azithromycin:** Commonly used for *M. pneumoniae*. Typical adult dose for community-acquired pneumonia is 500 mg on day 1, followed by 250 mg once daily for 4 days.
* **Doxycycline:** Often used for *M. pneumoniae* and *M. genitalium*. Typical adult dose for *M. pneumoniae* pneumonia is 100 mg twice daily for 7-14 days. For *M. genitalium*, doxycycline 100 mg twice daily for 7 days is a common regimen, though resistance is increasing.
* **Levofloxacin/Moxifloxacin:** May be used for resistant *M. pneumoniae* or *M. genitalium*. Levofloxacin 500 mg once daily for 7-10 days or moxifloxacin 400 mg once daily for 7 days are examples.
## Pediatric Dosing
Dosing in children depends on age, weight, the specific *Mycoplasma* species, and the antibiotic chosen. Local guidelines and prescribing information should be consulted.
* **Azithromycin:** For *M. pneumoniae* in children, typical dosing varies by age and indication. For example, a common regimen for children 6 months or older with community-acquired pneumonia is 10 mg/kg on day 1 (maximum 500 mg), followed by 5 mg/kg once daily for 4 days (maximum 250 mg).
* **Doxycycline:** Generally not recommended for children younger than 8 years of age due to potential tooth discoloration.
## Dose Adjustments
Dose adjustments are typically based on the chosen antibiotic agent and the patient's renal or hepatic function, not on the *Mycoplasma* pathogen itself. Consult specific antibiotic prescribing information for dose adjustment guidelines (e.g., in severe renal impairment).
## Contraindications
Contraindications apply to the specific antibiotic prescribed to treat the *Mycoplasma* infection. For example, macrolides are contraindicated in patients with a known hypersensitivity to the drug. Doxycycline is generally contraindicated in children younger than 8 years.
## Adverse Effects
Adverse effects are associated with the antibiotic used for treatment.
* **Macrolides (e.g., Azithromycin):** Gastrointestinal upset (nausea, vomiting, diarrhea), QT prolongation, rash.
* **Tetracyclines (e.g., Doxycycline):** Photosensitivity, gastrointestinal upset, tooth discoloration (in young children), esophageal irritation.
* **Fluoroquinolones (e.g., Levofloxacin, Moxifloxacin):** Tendon rupture, QT prolongation, CNS effects (dizziness, confusion), dysglycemia, C. difficile-associated diarrhea.
## Key Drug Interactions
Drug interactions are specific to the antibiotic used.
* **Macrolides:** May increase serum concentrations of certain drugs metabolized by CYP3A4 (e.g., statins, warfarin, digoxin).
* **Tetracyclines:** Absorption is decreased by divalent and trivalent cations (e.g., calcium, iron, magnesium, aluminum). Administer at least 2 hours before or 4-6 hours after these products.
* **Fluoroquinolones:** Absorption is decreased by polyvalent cations (e.g., antacids, sucralfate, iron, zinc). Separate administration by at least 2 hours. May increase levels of theophylline and warfarin.
## Monitoring
Monitoring is directed at the efficacy of the antibiotic treatment and the patient's response.
* Clinical improvement of symptoms (e.g., cough, fever, respiratory status).
* Adverse effects of the prescribed antibiotic.
* **For *M. genitalium*:** Consider test-of-cure (nucleic acid amplification test) if symptoms persist, given high rates of treatment failure due to resistance.
## Clinical Pearls
* *Mycoplasma* species are often referred to as "atypical" bacteria due to their unique cell wall structure and presentation.
* Antibiotics targeting cell wall synthesis (penicillins, cephalosporins) are ineffective against *Mycoplasma*.
* Resistance to macrolides, particularly azithromycin, is a growing concern for *M. genitalium*. Nucleic acid amplification testing for *M. genitalium* may include resistance testing or test-of-cure is recommended.
* Doxycycline is effective but should be used cautiously in children.
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**Disclaimer:** This information is intended for clinical decision support and does not replace professional medical judgment. Always consult the most current prescribing information for any medication and local institutional protocols before making treatment decisions.
