Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

with pneumonia

1st line – macrolide or tetracycline

Back
ACUTE
|
with pneumonia
1st line – 

macrolide or tetracycline

Mycoplasma are susceptible to macrolides (e.g., azithromycin, clarithromycin, and erythromycin). Because generally there is no diagnosis of the pathogen at the time of treatment, initiation of the treatment is usually empirical.

Antibiotic choice may be guided by relevant local guidelines for pneumonia.

Macrolides are effective for respiratory infections, although macrolide-resistant M pneumoniae cases have been reported in the Western Pacific (53.4%), South East Asia (9.8%), the Americas (8.4%), and Europe (5.1%).[15]

M pneumoniae is also susceptible to tetracyclines (e.g., doxycycline and minocycline).

Treatment course depends on type of infection present. In countries where macrolide resistance in M pneumoniae is highly prevalent, it seems that tetracyclines (doxycycline or minocycline) are likely to be more effective than macrolides or fluoroquinolones.[47][48]

Primary options

azithromycin: children: 10 mg/kg once daily on the first day, followed by 5 mg/kg once daily for 4 days; adults: 500 mg orally once daily on the first day, followed by 250 mg once daily for 4 days

OR

clarithromycin: children: 15 mg/kg/day given in divided doses every 12 hours, maximum 1000 mg/day; adults: 500 mg orally (immediate release) twice daily

OR

erythromycin base: children: 30-50 mg/kg/day given in divided doses every 6 hours; adults: 500 mg orally four times daily

Secondary options

doxycycline: children >8 years of age: 2.2 mg/kg twice daily on the first day, followed by 2.2 mg/kg once daily; adults: 100 mg orally twice daily on the first day, followed by 100 mg once daily

OR

minocycline: children >8 years of age: 4 mg/kg initially, followed by 2 mg/kg twice daily; adults: 200 mg orally initially, followed by 100 mg twice daily

2nd line – fluoroquinolone

Back
ACUTE
|
with pneumonia
2nd line – 

fluoroquinolone

A fluoroquinolone antibiotic may be considered as second-line treatment if previous antibiotics fail.

Fluoroquinolones may also be appropriate for patients with pneumonia and comorbidities such as diabetes, alcohol-use disorder, and chronic heart, lung, liver, or renal disease.[31]

However, because the use of fluoroquinolones may promote resistance, their widespread use in the community is discouraged.

Fluoroquinolones are associated with serious, disabling, and potentially irreversible adverse effects, including tendonitis, tendon rupture, arthralgia, neuropathies, and other musculoskeletal or nervous system effects.[49][50] The Food and Drug Administration (FDA) has also issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[51]

Levofloxacin and moxifloxacin are usually preferred for respiratory infections.

Treatment course depends on type of infection present.

Fluoroquinolones are not routinely used in children.

Primary options

levofloxacin: children: consult specialist for guidance on dose; adults: 500-750 mg orally once daily

OR

moxifloxacin: children: consult specialist for guidance on dose; adults: 400 mg orally/intravenously once daily

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer