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# Mycoplasma (pathogen, not a drug)
## Overview
*Mycoplasma* is a genus of bacteria that lack a cell wall. They are a common cause of various infections, particularly respiratory and genitourinary. Treatment typically involves antibiotics that are effective against wall-less bacteria.
## Primary Indications
* Community-acquired pneumonia (CAP)
* Bronchitis
* Pharyngitis
* Genitourinary infections (e.g., urethritis)
## Adult Dosing
Dosing depends on the specific antibiotic chosen, the severity of infection, and the patient's renal and hepatic function. Common agents and typical durations include:
* **Azithromycin:** 500 mg orally on day 1, then 250 mg orally daily for 4 more days.
* **Clarithromycin:** 500 mg orally twice daily for 7-14 days.
* **Doxycycline:** 100 mg orally twice daily for 7-14 days.
* **Levofloxacin:** 500 mg orally once daily for 7-14 days.
## Pediatric Dosing
Dosing depends on the specific antibiotic, age, weight, and severity of infection. Local protocols should be consulted.
* **Azithromycin:**
* 2 years and older: 10 mg/kg orally on day 1 (max 500 mg), then 5 mg/kg orally daily for 4 days (max 250 mg/day).
* **Clarithromycin:**
* 6 months to 12 years: 7.5 mg/kg orally twice daily (max 500 mg/dose) for 10 days.
* **Doxycycline:**
* Generally avoided in children younger than 8 years due to potential tooth discoloration, but may be used if benefits outweigh risks. Dosing is typically 4.4 mg/kg orally divided into two doses (max 100 mg/dose) for 7-14 days.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments may be necessary for some agents (e.g., clarithromycin, levofloxacin) depending on the degree of renal impairment. Consult specific drug monographs.
* **Hepatic Impairment:** Dose adjustments may be necessary for some agents (e.g., clarithromycin, azithromycin). Consult specific drug monographs.
## Contraindications
Contraindications are specific to the chosen antibiotic. For example, macrolides are contraindicated in patients with a known hypersensitivity. Fluoroquinolones have several contraindications, including a history of tendon disorders related to fluoroquinolone use.
## Adverse Effects
Adverse effects are specific to the chosen antibiotic. Common adverse effects include:
* **Macrolides (Azithromycin, Clarithromycin):** Gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), rash.
* **Tetracyclines (Doxycycline):** Photosensitivity, gastrointestinal upset, tooth discoloration (in children <8 years), esophageal irritation.
* **Fluoroquinolones (Levofloxacin):** Tendon rupture, CNS effects (dizziness, headache), QT interval prolongation, peripheral neuropathy.
## Key Drug Interactions
Drug interactions are specific to the chosen antibiotic. For example:
* **Azithromycin/Clarithromycin:** May increase serum concentrations of certain drugs metabolized by CYP3A4 (e.g., warfarin, theophylline, carbamazepine).
* **Doxycycline:** Absorption may be reduced by divalent and trivalent cations (e.g., antacids, iron supplements, dairy products).
* **Levofloxacin:** May increase the anticoagulant effect of warfarin. Antidiabetic effects may be altered with concomitant use of certain oral hypoglycemics.
## Monitoring
* Clinical signs and symptoms of infection.
* Adverse effects related to the specific antibiotic.
* Renal and hepatic function, especially in patients with pre-existing impairment or those on potentially nephro/hepatotoxic agents.
* For fluoroquinolones, monitor for signs of tendon inflammation or rupture.
## Clinical Pearls
* *Mycoplasma pneumoniae* is a common cause of atypical pneumonia, often presenting with a gradual onset of symptoms, including dry cough, headache, and malaise.
* Antibiotic selection should be guided by local resistance patterns and patient factors.
* Duration of therapy should be adequate to ensure eradication of the pathogen.
* Always consult current prescribing information for the most up-to-date and complete drug information.
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*Disclaimer: This information is intended for healthcare professionals and should not be a substitute for professional medical advice. Always consult the most current prescribing information and guidelines before making any clinical decisions. Dosing and recommendations may vary based on individual patient factors, local protocols, and evolving clinical evidence.*
