What is the first choice drug for treating mycoplasma pneumonia? Is hospitalization necessary? Four major questions, authoritative answers

The Beijing Municipal Health Commission has organized experts to answer questions and resolve doubts regarding Mycoplasma pneumonia and medication, which have recently raised concerns among the public.

1. What is the drug of choice for treating Mycoplasma pneumoniae infection?

Mycoplasma pneumoniae is a microorganism with a size between bacteria and viruses. Pneumonia caused by Mycoplasma pneumoniae is the most common community-acquired pneumonia in children aged 5 and above in China. It accounts for 10%-40% of community-acquired pneumonia in hospitalized children. Regional epidemics occur every 3-8 years.

Macrolides are the first choice for treating Mycoplasma pneumoniae infection in children. Commonly used macrolides include azithromycin, erythromycin, clarithromycin, etc. In recent years, with the widespread use of macrolides in children's respiratory infections, drug-resistant Mycoplasma pneumoniae infections in children have been on the rise.

2. Are there any alternative medicines?

New tetracycline antibiotics are alternative drugs for the treatment of Mycoplasma pneumonia, mainly including doxycycline and minocycline. They have definite efficacy against drug-resistant Mycoplasma pneumonia, and are used to treat refractory Mycoplasma pneumonia with suspected or confirmed Mycoplasma pneumonia resistance, Mycoplasma pneumonia that is unresponsive to macrolides, and severe Mycoplasma pneumonia. Because they may cause yellowing of teeth and poor development of tooth enamel, they are only suitable for children over 8 years old. Children under 8 years old are considered to be using the drug off-label. Minocycline is relatively effective, and doxycycline is more safe. Within the recommended dose and course of treatment, there are no reports of persistent yellowing of teeth.

Another class of alternative drugs is quinolones, of which levofloxacin, ciprofloxacin, and moxifloxacin are commonly used. Due to the risk of cartilage damage in young animals and tendon rupture in humans, their use in children under 18 years of age in my country is considered off-label. In 2011, the first community-acquired pneumonia treatment guideline for infants and children aged ≥ 3 months, jointly developed by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America, was recommended. Quinolones can also be used as alternative drugs for adolescents with mature bones or children aged ≥ 6 months who cannot tolerate macrolides. In the United States and Japan, they can be used in children as alternative drugs.

Clinically, macrolides are still recommended as first-line drugs, but when drug resistance exists, tetracyclines and quinolones can also be used according to the condition.

3. How to treat mycoplasma pneumonia? Is hospitalization required?

First, check whether mycoplasma pneumonia is mild or severe. Mild cases can generally be controlled by macrolide drugs such as azithromycin, clarithromycin, and erythromycin, but after the body temperature returns to normal, the cough may continue for about 2 weeks, and the pneumonia shadows on the chest X-ray are basically absorbed, so there is no need to recheck the chest X-ray.

Severe patients need to be hospitalized and need intravenous infusion of macrolide drugs. Due to the high drug resistance rate in China, if macrolide drugs have been used for 3 days and are ineffective, they can be replaced with new tetracycline drugs such as minocycline. For more serious cases, drugs such as levofloxacin can be used. Severe cases may have mixed viral or bacterial infections and also need to be treated with corresponding drugs. In addition, if combined infections are excluded, hormones need to be used to suppress the body's excessive inflammatory response to mycoplasma, and bronchoscopes need to be used to clear the viscous inflammatory secretions blocking the airways.

Severely ill patients usually receive combination treatments, similar to cocktail therapy, in which all types of treatment play an important role, rather than relying solely on macrolide drugs.

4. Is there any difference in the effectiveness of domestic and imported azithromycin?

Currently, the drugs used for treatment are basically domestically produced, especially azithromycin, which has basically the same effects as those imported from abroad.

Source: Beijing Municipal Health Commission (Expert: Zhao Shunying, Chief Physician and Doctoral Supervisor, Department of Respiratory Medicine II, Beijing Children's Hospital)