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# Mycoplasma (pathogen, not a drug)
## Overview
*Mycoplasma* is a genus of bacteria that lacks a cell wall. Some species are part of the normal human microbiota, while others are pathogenic and can cause a variety of infections.
## Primary Indications
*Mycoplasma* species are not treated with a specific drug named "Mycoplasma". Instead, infections caused by pathogenic *Mycoplasma* species (e.g., *Mycoplasma pneumoniae*, *Mycoplasma genitalium*) are treated with antibiotics. The choice of antibiotic depends on the specific *Mycoplasma* species and the site of infection.
## Adult Dosing
Antibiotic treatment for *Mycoplasma* infections varies. Common agents and typical regimens include:
* **Macrolides (e.g., Azithromycin, Clarithromycin):** Often a first-line choice for respiratory infections.
* Azithromycin: 500 mg once on day 1, then 250 mg once daily for 4 days is a common regimen for community-acquired pneumonia.
* Clarithromycin: 500 mg twice daily for 7-14 days.
* **Tetracyclines (e.g., Doxycycline):** Another option for respiratory and urogenital infections.
* Doxycycline: 100 mg twice daily for 7-14 days.
* **Fluoroquinolones (e.g., Levofloxacin, Moxifloxacin):** May be used for macrolide-resistant strains or in specific situations.
* Levofloxacin: 500 mg once daily for 7-14 days.
* Moxifloxacin: 400 mg once daily for 7-14 days.
**Note:** Dosing for *Mycoplasma genitalium* infections, particularly those causing urethritis or cervicitis, often requires longer courses or combination therapy due to increasing resistance. Refer to specific guidelines for these indications. Local resistance patterns can significantly influence antibiotic choice and duration.
## Pediatric Dosing
Dosing for pediatric patients depends on the specific *Mycoplasma* species, the site of infection, and the chosen antibiotic.
* **Azithromycin:** For community-acquired pneumonia in children aged 6 months and older, the typical dose is 10 mg/kg on day 1 (maximum 500 mg), followed by 5 mg/kg on days 2-5 (maximum 250 mg per day).
* **Doxycycline:** Generally not recommended for children younger than 8 years due to potential tooth discoloration, although risks are likely outweighed by benefits in severe infections. If used, dosing is typically weight-based (e.g., 4 mg/kg/day divided into two doses).
**Uncertainty:** Dosing outside of established guidelines for specific indications in children should be carefully considered and may require specialist consultation.
## Dose Adjustments
* **Renal Impairment:** Most commonly used antibiotics (azithromycin, doxycycline, levofloxacin) require dose adjustment in severe renal impairment, though specific guidelines vary. Consult product information or renal dosing guidelines.
* **Hepatic Impairment:** Caution is advised. Dose adjustments are not typically specified but may be necessary in severe hepatic dysfunction.
## Contraindications
Contraindications are specific to the chosen antibiotic, not *Mycoplasma* itself. Examples include:
* Known hypersensitivity to the antibiotic or its components.
* Certain fluoroquinolones are contraindicated in patients with a history of tendon disorders related to fluoroquinolone use.
* Macrolides should be used with caution in patients with known QT prolongation or on other QT-prolonging agents.
## Adverse Effects
Adverse effects are antibiotic-specific. Common ones include:
* **Macrolides:** Gastrointestinal upset (nausea, vomiting, diarrhea), rash, QT prolongation, liver enzyme abnormalities.
* **Tetracyclines:** Photosensitivity, gastrointestinal upset, tooth discoloration (in young children), esophageal irritation.
* **Fluoroquinolones:** Gastrointestinal upset, headache, dizziness, tendonitis/tendon rupture, QT prolongation, CNS effects, dysglycemia.
## Key Drug Interactions
Drug interactions are antibiotic-specific.
* **Macrolides:** May interact with CYP3A4 substrates (e.g., statins, warfarin, carbamazepine) leading to increased concentrations.
* **Tetracyclines:** Absorption reduced by divalent and trivalent cations (e.g., calcium, iron, magnesium, zinc) found in dairy products, antacids, and iron supplements. Separate administration by at least 2 hours.
* **Fluoroquinolones:** Absorption reduced by divalent and trivalent cations. May increase levels of theophylline, warfarin, and antidiabetic agents.
## Monitoring
* Clinical signs and symptoms of infection improvement.
* Laboratory parameters as indicated by the chosen antibiotic.
* For fluoroquinolones, monitor for signs of tendonitis.
## Clinical Pearls
* *Mycoplasma* is a common cause of atypical pneumonia, especially in school-aged children and young adults.
* The absence of a cell wall makes *Mycoplasma* intrinsically resistant to beta-lactam antibiotics (penicillins, cephalosporins).
* Macrolide resistance in *Mycoplasma pneumoniae* is increasing globally, necessitating consideration of alternative agents like doxycycline or fluoroquinolones, particularly in cases of treatment failure or known macrolide-resistant areas.
* *Mycoplasma genitalium* is a common cause of sexually transmitted infections and requires specific diagnostic and treatment approaches due to significant antimicrobial resistance.
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*This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines to ensure appropriate patient care.*
