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# Mycoplasma pneumoniae
## Overview
*Mycoplasma pneumoniae* is a bacterium that can cause respiratory infections, most commonly bronchitis and pneumonia. It is a common cause of community-acquired pneumonia, particularly in children and young adults.
## Primary Indications
Treatment of *Mycoplasma pneumoniae* infections, including:
* Community-acquired pneumonia (walking pneumonia)
* Bronchitis
* Pharyngitis
## Adult Dosing
Recommended treatment regimens include macrolides, tetracyclines, or fluoroquinolones. Duration of therapy is typically 7-14 days. Specific dosing depends on the chosen agent and clinical scenario.
* **Azithromycin:** 500 mg orally on day 1, followed by 250 mg orally once daily on days 2-5.
* **Doxycycline:** 100 mg orally twice daily for 7-14 days.
* **Levofloxacin:** 500 mg orally once daily for 5-7 days.
* **Moxifloxacin:** 400 mg orally once daily for 5-7 days.
## Pediatric Dosing
Dosing for children varies by age, weight, and the chosen antibiotic.
* **Azithromycin:**
* Children 1-5 years: 10 mg/kg orally on day 1 (max 500 mg), then 5 mg/kg orally on days 2-5 (max 250 mg/day).
* Children >5 years: 500 mg orally on day 1, then 250 mg orally once daily on days 2-5.
* **Doxycycline:** Generally not recommended in children <8 years due to potential for tooth discoloration. If necessary, doses are typically weight-based (e.g., 2-4 mg/kg/day divided every 12 hours).
* **Fluoroquinolones:** Generally reserved for specific situations in children due to concerns about arthropathy. Consult infectious disease specialists for guidance.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments may be necessary for certain agents (e.g., fluoroquinolones). Consult specific drug monographs.
* **Hepatic Impairment:** Use with caution; specific adjustments may be needed for some agents.
## Contraindications
Contraindications are specific to the chosen antibiotic agent and include known hypersensitivity to the drug or its class. For example, macrolides are contraindicated in patients with a history of cholestatic jaundice/hepatic dysfunction associated with prior macrolide use.
## Adverse Effects
Adverse effects are dependent on the chosen antibiotic. Common side effects include:
* **Macrolides:** Gastrointestinal upset (nausea, vomiting, diarrhea), QT prolongation.
* **Tetracyclines (Doxycycline):** Photosensitivity, gastrointestinal upset, tooth discoloration (in young children), esophageal irritation.
* **Fluoroquinolones:** Tendon rupture, QT prolongation, CNS effects (dizziness, confusion), *C. difficile*-associated diarrhea.
## Key Drug Interactions
Interactions are specific to the chosen antibiotic.
* **Azithromycin:** May increase levels of digoxin, warfarin, and certain statins.
* **Doxycycline:** May decrease the efficacy of oral contraceptives; absorption reduced by cations (e.g., calcium, iron, magnesium, aluminum).
* **Fluoroquinolones:** May increase levels of theophylline and warfarin. Antacids and dairy products can reduce absorption.
## Monitoring
* Monitor for clinical improvement (resolution of fever, cough, and other symptoms).
* Monitor for adverse drug reactions.
* Monitor drug levels if indicated for specific agents or in patients with altered pharmacokinetics.
## Clinical Pearls
* *Mycoplasma pneumoniae* is a common cause of atypical pneumonia.
* Treatment duration is often longer than for typical bacterial pneumonias.
* Resistance to macrolides has been reported, particularly in certain geographic regions. If treatment fails, consider alternative agents or testing for resistance.
* Doxycycline is a preferred agent for adults and adolescents.
* Fluoroquinolones should generally be reserved for cases with documented resistance or failure of first-line therapy due to potential for serious adverse effects.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors, local resistance patterns, and institutional protocols.
