Mycoplasma pneumoniae

Authors: Bin Cao, M.D.,  Julia A. McMillan, M.D.


Mycoplasma pneumoniae is a Mollicute, a class of bacteria that lack a cell wall. The class includes organisms that are both commensals and pathogens for animals and plants, but the human is the only known host for M. pneumoniae. Lack of a cell wall makes it possible to grow M. pneumoniae in the laboratory on cell-free media only if it is supplemented with sterols and other nutrients provided by yeast extract and animal serum.


M. pneumoniae was first recognized as a human pathogen when it was isolated from adults with atypical pneumonia syndrome (9, 12). Other causes of this syndrome include respiratory viruses, Legionella species, Chlamydia pneumoniae, and Chlamydia psittaci. M. pneumoniae causes respiratory infection in children of all ages, adolescents, and adults in the second through the fourth decades of life. Upper respiratory symptoms are its most common manifestation in children less than 5 years of age (1, 15, 16). Pneumonia due to M. pneumoniae has been shown to be responsible for approximately 20% of the lower respiratory tract disease seen in junior high and high school students and up to 50% in college students and young adults (10, 14, 16, 18, 29).  Prevalence of M. pneumoniae infection may vary according to population and diagnostic methods used. M. pneumoniae infection tends to show cyclic epidemics every 3-5 years; these outbreaks are particularly likely to occur in summer or early fall (1, 13, 20, 26).

Clinical Manifestations

M. pneumoniae causes upper and lower respiratory tract infections. The onset is gradual and fever and cough are the most common presenting manifestations. The cough is usually nonproductive and can be prolonged and severe. With the exception of headache, systemic symptoms such as chills, gastrointestinal manifestations, myalgias are uncommon. Symptoms and severity of illness due to M. pneumoniae was similar in younger and older patients, and the mortality rate was low, even in the elderly (4, 28).

The Japanese Respiratory Society (JRS) guidelines on CAP included five parameters for differentiation between atypical (M. pneumoniae) and bacterial (S. pneumoniae) pneumonia. These parameters were: 1) persistent cough, 2) limited auscultatory findings on chest examination, 3) minimal sputum production, 4) a peripheral white blood cell count below 10,000/mm3. 5) nonsevere co-morbid illnesses. Based on prospective data from 4532 patients with CAP included in the German CAP Competence Network (CAPNETZ), the authors found that patients with M. pneumoniae pneumonia were significantly younger, had less co-morbidity, presented with a less severe disease, showed a lower inflammatory response in terms of leukocyte counts and CRP values, and had better outcomes (43). Cao and coauthors also demonstrated that compared with bacterial and viral pneumonia, CAP patients infected with M. pneumoniae were younger, had lower PSI score, and less likely to have adequate sputum for gram stain and culture (5).

Though effective in reducing symptoms, antibiotic therapy does not reliably eradicate shedding of M. pneumoniae. When initiated within the first 3-4 days of illness, antibiotics are beneficial in both adults and children with lower respiratory tract disease (17, 40, 41), though their impact on upper respiratory tract symptoms has not been well studied. Shedding of the organism from the respiratory tract may persist for weeks to months, even in patients with minimal or no symptoms, and even after appropriate antibiotic therapy (39, 41).

Extrapulmonary Manifestations: A wide variety of skin manifestations has been reported – the most common being erythema multiforme (Stevens-Johnson syndrome). Vascular complications include Raynaud’s phenomenon and vascular occlusion with infarction. Cardiac abnormalities have been reported in hospitalized patients with arrhythmias being the most common manifestation. Arthritis, neurological manifestations, hepatitis, pancreatitis, and ocular disease have also been reported. Most reports are anecdotal and disease is usually attributed to M. pneumoniae on the basis of antibody testing alone; however, isolation of the organism from blood, CSF, synovial fluid, and skin lesions in some patients attests to the fact that dissemination can occur. The pathogenesis of these manifestations is unknown, but immunological reactions and cold agglutinins have been postulated.

back to top

Laboratory Diagnosis

When sputum is available, Gram stain shows leukocytes, but no predominant bacteria. Conventional culture using pleuropneumonia-like organism (PPLO) broth, which requires more than 2 weeks, has not been carried out routinely. Compared with serologic tests, or molecular techniques, sensitivity of culture may be 60-70% (21, 30). Culture methods are only used for study of resistance in M. pneumoniae.

Serological methods are now frequently used for diagnosis of M. pneumoniae infections. But reliable diagnosis of M. pneumoniae infections still can not be made on the basis of single acute-phase sera; paired sera obtained during acute and convalescent phases in order to demonstrate rises in antibody titers; fourfold increase is thought to be significant (3, 34). Neither culture nor serologic testing can provide timely information for guiding choice of chemotherapeutic agents to use for early intervention.

Cold agglutinins are IgM antibodies that may appear in the second week of illness. They are detected at a titer of greater than 1:64 in 50-75% of patients with pneumonia due to M pneumoniae, but the test is nonspecific rendering it more of historical value than of clinical utility.

PCR diagnosis is already available in some centers, will become increasingly available, and is likely to replace serodiagnosis in the longer term. Real-time PCR has both high sensitivity and high specificity and can detect pathogen DNA even when damaged by empirical administration of antibiotics. Sensitivity (60-100%) and specificity (96.7-100%) of real-time PCR are both higher than those of serologic assays for M. pneumoniae (11, 19, 34). Almost all PCR-positive cases (>90%) also were confirmed serologically (31, 34).  Where available, PCR of sputum or lower respiratory tract sample should be the method of choice for the diagnosis of M. pneumoniae. In the absence of sputum, a throat swab for M. pneumoniae PCR is recommended.

back to top


M. pneumoniae is spread through respiratory droplets and attaches to ciliated respiratory epithelial cells via an attachment protein. Toxins are produced, leading to ciliostasis and eventual desquamation of ciliated epithelial cells. Macrophages and polymorphonuclear leukocytes contribute to the inflammatory exudates in the upper, and in the case of pneumonia, the lower respiratory tract.


Single Drug

Intrinsically, absence of cell walls in M. pneumoniae confers resistance to β-lactams. M. pneumoniae usually are sensitive to all macrolides, ketolides and tetracyclines (Table 1).   Macrolide resistant M. pneumoniae isolates possessing a neucleolide mutation in 23S rRNA first were isolated from pediatric patients with CAP from Japan 2001 (33). In Japanese adult CAP patients, macrolide resistant strains first were isolated in 2007 (23). Emergence of macrolide resistant isolates has not been reported not only in Japan, but also in other countries, including France, the USA, Denmark, and China. A notably high isolation rate of macrolide resistant strains both from pediatric patients (90%) and adult patients (68.7%) was reported in China (6, 27) (Table 2) Tetracyclines are administrated for treatment of M. pneumoniae infections in adults and in pediatric patients > 8 years, but development of resistance to tetracyclines has not yet been reported.  Telithromycin is the first of a new family of antimicrobials, the ketolides, to be approved for use in treatment of community-acquired pneumonia. MICs for minocycline and fluoroquinolones in macrolide resistant strains were equivalent to those in susceptible strains. No strains having resistance to minocycline and fluoroquinolones have been observed among clinical isolates. However, emergence of infections with fluoroquinolone-resistant M. pneumoniae might occur, considering the increasing use fluoroquinolone prescription rate among adult patients.

Combination Drugs

Susceptibility of M. pneumoniae to single drug therapy has made it unnecessary to study susceptibilities using combination drugs.

 back to top


Drug of Choice

Macrolides usually are considered the first-line choice for the treatment of M. pneumoniae infection. Treatment of M. pneumoniae pneumonia with clarithromycin or azithromycin results in clinical benefit equal to that seen with erythromycin therapy (7, 8, 37, 38) and a three-day regimen of azithromycin appears to be as effective as five days (37). Microbiologic cure has not been carefully compared in these studies, but because the clinical significance of bacteriologic persistence is not known, eradication may not be an appropriate measure for effectiveness. Treatment of M. pneumoniae pneumonia with roxithromycin resulted in good to excellent results in 12 of 13 patients and eradication of the organism in 4 of the 6 patients cultured (24).

Early studies in adults indicated that both erythromycin and tetracycline were more effective than placebo (25) or penicillin (35, 39) in reducing duration of symptoms, hospitalization, and abnormal chest x-ray in young adults (military recruits and college students) with M. pneumoniae pneumonia. Etiology was documented by culture and/or paired anti-mycoplasmal antibody response in these studies. In children less impressive benefits from antibiotic therapy have been demonstrated (17, 36). Initiation of therapy within the first five days of illness is important for the achievement of maximal benefit.

Alternative Therapy

At present, there is limited evidence on the clinical significance of macrolide-resistant M. pneumoniae infection among pediatric patients. Suzuki and coworkers showed that the total febrile days and the number of febrile days during macrolide administration were longer in patients infected by macrolide-resistant M. pneumoniae (33). In this study, duration of therapy and time to resolution of fever were significantly longer in those infected with resistant strains. No clinical improvement was seen 72 hours after initiation of azithromycin in patients infected with M. pneumoniae with MIC ≥ 2μg/ml of azithromycin.  When macrolides are ineffective against M. pneumoniae infection, tetracycline or doxycycline are alternative agents. Respiratory tract fluoroquinolones, such as moxifloxacin, levofloxacin, sparfloxacin, and gemifloxacin may be used for adult patients with macrolide resistant M. pneumoniae infections. Fluoroquinolones are not licensed for use in children.

Empiric Therapy

Timely laboratory diagnosis of M. pneumoniae and other causes of atypical pneumonia (Chlamydia pneumoniae, Legionella pneumoniae, Chlamydia psittaci) usually is not available. Presumptive antibiotic therapy should be selected based on expected effectiveness against these pathogens as well as against the typical bacterial causes of pneumonia (Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae). Treatment guidelines for adults with community-acquired pneumonia (2) recommend a macrolide, one of the fluoroquinolones with substantial activity against S. pneumoniae, or doxycycline, for patients who do not require hospitalization. Addition of a beta-lactam antibiotic or single drug therapy using a fluoroquinolone with increased activity against S. pneumoniae is recommended for those who require hospitalization. Clinical trails of telithromycin indicate that it should be expected to be as effective as the macrolides or the quinolones in treating community-acquired pneumonia. Recommended antibiotic doses are listed in Table 3.

Extrapulmonary Disease

The role of antibiotic therapy in treatment of extrapulmonary M. pneumoniae disease has not been well studied. Though immune mechanisms are purported to have a role in hemolysis, CNS involvement, and arthritis, corticosteroid therapy has not been shown to be of benefit. Underlying Diseases Patients with sickle cell disease have been shown to have more severe and prolonged respiratory tract symptoms when infected with M. pneumoniae than do otherwise healthy individuals. Presumptive antibiotic therapy for community-acquired pneumoniae in such patients should include therapy effective against M. pneumoniae. Mycoplasmas other than M. pneumoniae have been found to cause arthritis and invasive disease in immunocompromised patients, but underlying immunodeficiency and immunosuppressive therapy have not been consistently found to be predisposing factors for complications associated with M. pneumoniae infection.

 back to top


Symptomatic therapy (non-steroidal anti-inflammatory medications) may be useful early in the course of infection to relieve fever, headache, and sore throat. Antitussive agents generally provide little relief from the prolonged cough.


Antibiotic therapy results in only modest improvement in cough, fever, myalgia, and other systemic complaints compared to untreated infection. With or without therapy the cough persists well beyond the resolution of generalized illness. As is the case with most causes of community-acquired pneumonia, the chest x-ray may remain abnormal for 4-6 weeks following acute infection.


There is no available vaccine to prevent M. pneumoniae infection.


Mycoplasma pneumoniae infection of household and other close contacts is frequent. Because prophylaxis using tetracycline or azithromycin may be of some benefit in preventing household spread, their use may be considered if such contacts have underlying respiratory conditions or sickle cell disease.

back to top


1. Alexander ER, Foy JM, Kenny GE, Kronmal RA, McMahan R, Clarke ER, MacColl WA, Grayston JT.  Pneumonia due to Mycoplasma pneumoniae: its incidence in the membership of a co-operative medical group. N Engl J Med 1966;275:131-136 [PubMed]

2. Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM,  Fine MJ.  Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis 2000;31:347 [PubMed]

3. Beersma MF, Dirven K, van Dam AP, Templeton KE, Claas EC, Goossens H. Evaluation of 12 commercial tests and the complement fixation test for Mycoplasma pneumoniae-specific immunoglobulin G (IgG) and IgM antibodies, with PCR used as the ‘‘gold standard’’. J Clin Microbiol. 2005;43:2277–85. [PubMed]  

4. Beovic´ B, Bonac B, Kese D, Avsic-Zupanc T, Kreft S, Lesnicar G, et al. Aetiology and clinical presentation of mild community. J Infect Chemother acquired bacterial pneumonia. Eur J Clin Microbiol Infect Dis. 2003;22:584–91.  [PubMed] 

5.  Bin Cao, Li-Li Ren, Fei Zhao, Richard Gonzalez, Shu-Fan Song, Lu Bai, Yu Dong Yin, Yu-Yu Zhang, Ying-Mei Liu, Ping Guo, Jian-Zhong Zhang, Jian-Wei Wang, Chen Wang. Viral and M. pneumoniae community acquired pneumonia and novel clinical outcome evaluation in ambulatory adult patients. Eur J Clin Microbiol Infect Dis 2010, in press 

6.  Bin Cao, Chun-Jiang Zhao, Yu-Dong Yin, Fei Zhao, Shu-Fan Song, Lu Bai, Jian-Zhong Zhang, Ying-Mei Liu,Yu-Yu Zhang, Hui Wang, Chen Wang. High Prevalence of Macrolide Resistance in Mycoplasma pneumoniae Isolates from Adult and Adolescent Patients with Respiratory Tract Infections. Clin Infect Dis (in press July 2010)

7. Block S, Hedrick J, Hammerschlag MR, Cassell GH, Craft JC.  Mycoplasma pneumoniae and Chlamydia pneumoniae in pediatric community-acquired pneumonia: comparative efficacy and safety of clarithromycin vs. erythromycin ethylsuccinate. Pediatr Infect Dis J 1995;14:471-477 [PubMed]

8. Cassell GH, Drnec J, Waites KB, Pate MS, Duffy LB, Watson HL, and McIntosh JC.  Efficacy of clarithromycin against Mycoplasma pneumoniae. J Antimicrob Chem 1991;27, Suppl A, 47-59.  [PubMed]

9.Chanock RM, Hayflick L, Barile MF. Growth on artificial medium of an agent associated with atypical pneumonia and its identification as a PPLO. Proc Nat Acad Sci USA 1962;48:41-49.  [PubMed] 

10. Denny FW, Clyde WA Jr, Glezen WP. Mycoplasma pneumoniae disease: clinical spectrum, pathophysiology, epidemiology, and control. J Infect Dis 1971;123:74-92. [PubMed]

11.  Dorigo-Zetsma JW, Zaat SA, Wertheim-van Dillen PM,Spanjaard L, Rijntjes J, van Waveren G, et al. Comparison of PCR, culture, and serological tests for diagnosis of Mycoplasma pneumoniae respiratory tract infection in children. J Clin Microbiol. 1999; 37: 14–7. [PubMed] 

12. Eaton MD, Meiklejohn G, van Herick W. Studies on the etiology of primary atypical pneumonia. J. Exp Med 1944;79:649-668. [PubMed] 

13.  Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumoniae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect. 2008;56:326–31. [PubMed] 

14.  Evans AS, Allen V, Sueltmann S. Mycoplasma pneumoniae infections in University of Wisconsin students. Am Rev Resp Dis 1967; 96:237-244. [PubMed]

15. Fernald GW, Collier AM, Clyde WA Jr. Respiratory infections due to Mycoplasma pneumoniae in infants and children. Pediatr 1975;55:327-335 [PubMed]

16. Foy HM, Grayston JT, Kenny GE, Alexander ER, McMahan R.   Epidemiology of Mycoplasma pneumoniae infection in families. J Amer Med Assoc 1967;197:137-144. [PubMed]

17. Foy HM, Kenny GE, McMahan, Mansy AM, Grayston JT.  Mycoplasma pneumoniae in an urban area. Five years of surveillance. J Amer Med Assoc 1970;214:1666-1672. [PubMed] 

18. Foy HM, Kenny GE, Cooney MK, Allan ID.  Long-term epidemiology of infections with Mycoplasma pneumoniae. J Infect Dis 1979;39:681-687. [PubMed]

19. Hardegger D, Nadal D, Bossart W, Altwegg M, Dutly F. Rapid detection of Mycoplasma pneumoniae in clinical samples by realtime PCR. J Microbiol Methods. 2000;41:45–51. [PubMed] 

20. Hauksdóttir GS, Jónsson T, Sigurdardóttir V, Löve A.  Seroepidemiology of Mycoplasma pneumoniae infections in Iceland 1987–96. Scand J Infect Dis. 1998;30:177–80. [PubMed] 

21. Ieven M, Ursi D, Van Bever H, Quint W, Niesters HG, Goossens H.  Detection of Mycoplasma pneumoniae by two polymerase chain reactions and role of M. pneumoniae in acute respiratory tract infections in pediatric patients. J Infect Dis. 1996;173:1445–52. [PubMed] 

22.  Ishida T, Miyashita N, Nakahama C:   Clinical differentiation of atypical pneumonia using Japanese guidelines. Respirology 2007, 12:104-10. [PubMed] 

23.Isozumi R, Yoshimine H, Morozumi M, Ubukata K, Ariyoshi K.  Adult case of community-acquired pneumonia caused by macrolide-resistant Mycoplasma pneumoniae. Respirology 2009;14(8):1206–8. [PubMed] 

24. Kaku M, Kohno S, Koga H, Ishida K, Hara K: Efficacy of roxithromycin in the treatment of mycoplasma pneumonia. Chemotherapy 1995;41:149-152. [PubMed] 

25.  Kingston JR, Chanock RM, Mufson MA, Hellman LP, James WD, Fox HH, Manko MA, Boyers J:  Eaton agent pneumonia. J Amer Med Assoc 1961;176:118-123. [PubMed] 

26. Lind K, Benzon MW, Jensen JS, Clyde WA Jr.  A seroepidemiological study of Mycoplasma pneumoniae infections in Denmark over the 50-year period 1946–1995. Eur J Epidemiol. 1997;13:581–6.  [PubMed] 

27. Liu Y, Ye X, Zhang H, Xu X, Li W, Zhu D, et al. Antimicrobial susceptibility of Mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant strains from Shanghai, China. Antimicrob Agents Chemother. 2009;53:2160–2. [PubMed]  

28. Marrie TJ. Epidemiology of mild pneumonia. Semin Respir Infect. 1998;13:3–7. [PubMed] 

29. Mogabgab WJ.  Mycoplasma pneumoniae and adenovirus respiratory illnesses in military and university personnel 1959-66. Am Rev Resp Dis 1968;97:345-358. [PubMed]

30. Morozumi M, Hasegawa K, Chiba N, Iwata S, Kawamura N, Kuroki H, et al. Application of PCR for Mycoplasma pneumoniae detection in children with community-acquired pneumonia.  J Infect Chemother. 2004;10:274–9. [PubMed] 

31. Morozumi M, Nakayama E, Iwata S, Aoki Y, Hasegawa K, Kobayashi R, et al. Simultaneous detection of pathogens in clinical samples from patients with community-acquired pneumonia by real-time PCR with pathogen-specific molecular beacon probes. J Clin Microbiol. 2006;44:1440–6. [PubMed] 

32. Niitu Y, Hasegawa S, Suetake T, Kubota H, Komatsu S, Horikawa M.   Resistance of Mycoplasma pneumoniae to erythromycin and other antibiotics. J Pediatr 1970;76:438-443. [PubMed] 

33. Okazaki N, Narita M, Yamada S, Izumikawa K, Umetsu M, Kenri T, Sasaki Y, Arakawa Y, Sasaki T. Characteristics of macrolide-resistant Mycoplasma pneumoniae strains isolated from patients and induced with erythromycin in vitro.  Microbiol Immunol. 2001;45:617–20. [PubMed] 

34. Otomo S, Yamamura J, Hayashi E, Nakamura T, Kakinuma H, Nakamoto Y, et al. Analysis of children with Chlamydophila (Chlamydia) pneumoniae and Mycoplasma pneumoniae respiratory infections by real-time PCR assay and serological tests.APMIS. 2008;116:477–83. [PubMed] 

35. Rasch JR, Mogabgab WJ. Therapeutic effect of erythromycin on Mycoplasma pneumoniae pneumonia. Antimicrob Agents Chemother 1965;5:693-698. [PubMed] 

36. Sabato AR, Martin AJ, Marmion BP, Kok TW, Cooper DM. Mycoplasma pneumoniae: Acute illness, antibiotics and subsequent pulmonary function. Arch Dis Child 1984;59:1034-1037. [PubMed] 

37. Schönwald S, Skerk V, Petricevic I, Car V, Majerus-Misic L, Gunjaca M. Comparison of three-day and five-day courses of azithromycin in the treatment of atypical pneumonia.  Eur J Clin Microbiol Infect Dis 1991;10:877-880. [PubMed] 

38. Schönwald S, Gunjaca M, Kolacny-Babic L, Car V, Gosev M.  Comparison of azithromycin and erythromycin in the treatment of atypical pneumonias. J Antimicrob Chemo 1990;25, Suppl A. 123-126. [PubMed] 

39. Shames JM, George RB, Holliday WB, Rasch JR, Mogabgab WJ. Comparison of antibiotics in the treatment of mycoplasmal pneumonia. Arch Intern Med 1970;125:680-684. [PubMed] 

40. Slotkin RI, Clyde WA Jr, Denny FW.  The effect of antibiotics on Mycoplasma pneumoniae in vitro and in vivo. Am J Epidemiol 1967;86:225-237. [PubMed] 

41. Smith CB, Chanock RM, Friedewald WT, Alford RH.  Mycoplasma infection in volunteers. Ann NY Acad Sci 1967;143:471-483. [PubMed] 

42. Stopler T, Gerichter CB, Branski D.  Antibiotic-resistant mutants of Mycoplasma pneumoniae. Israel J Med Sci 1980;16:169-173. [PubMed] 

43. von Baum H, Welte T, Marre R, Suttorp N, Lück C, Ewig S. Mycoplasma pneumoniae pneumonia revisited within the German Competence Network for Community-acquired pneumonia (CAPNETZ). BMC Infectious Diseases 2009;9:62. [PubMed]

back to top



Table 1.  Comparative Activity of Antimicrobial Agents against Mycoplasma Pneumoniae

Antibiotic  MIC90 (ug/ml)   MIC50 (ug/ml)     Range (ug/ml)
     Erythromycin           < 0.004 < 0.004 < 0.004-.063
     Clarithromycin < 0.031 < 0.004 < 0.004-.125
     Azithromycin            < 0.0027 0.002    < 0.002-0.0027
     Roxithromycin 0.0625  0.0313 0.0156-0.0625
  Telithromycin                    < 0.015 < 0.015  
     Tetracycline   0.2        0.06-0.4
     Doxycycline   0.4        0.1-1.2
     Ofloxacin 1.0                      0.5-1.0
     Sparfloxacin 0.063                  0.031-0.063
     Levofloxacin            0.5 1.0 0.5-1.0


Table 2. MICs Distribution of 9 Antimicrobial Agents for 67 M. pneumoniae Isolated from 356 Adult Patients with CAP or Upper RespiratoryTract Infections in Beijing Chao Yang Hospital 2008-2009

Antimicrobial agents No. of strains with MIC (μg/ml) of:
≤0.008 0.016 0.032 0.064 0.125 0.25 0.5 1 2 4 8 16 32 64 128 256 >256
Erythromycin 21                       1   6 14 25
Clarithromycin 21                     1   1 15 25 4
Azithromycin 21     1         3 21 17 3 1        
Ciprofloxacin 1       1 15 48 2                  
Levofloxacin 4       3 51 6 2 1                
Gatifloxacin 1 16 41 9                          
Moxifloxacin 1 11 55                            
Tetracycline   1 9 20 24 9 4                    
Minocycline   2 13 29 16 4 3                    


Table 3:  Dose and Duration of Recommended Antimicrobial Therapy for Mycoplasma pneumoniae Pneumonia

Antibiotic      Dose   Duration
Erythromycin Adults: 1-2 grams/day divided qid           Children*: 40 mg/kg/day divided qid   10 days   10 days  
Clarithromycin Adults: 250-500 mg/day divided bid Children*: 15 mg/kg/day divided bid   10 days   10 days 
Azithromycin Adults: 500 mg on day 1 followed by 250 mg/d on days 2-5   OR 500 mg/d   Children*: 10 mg/kg on day 1 followed by 5 mg/kg/day x 4 days   5 days total     3 days total     5 days total 
Telithromycin    Adults: 800 mg once daily           5-10 days 
Moxfloxacin      Adults only:                                                                            400 mg daily   10 days  
Levofloxacin     Adults only: 500 mg/day                                                       7-14 days
Tetracycline      Adults: 1-2 grams/day divided qid           Children > 7 years*: 25-50 mg/kg/day div q 6 hrs              10 days   10 days
Doxycycline      Adults: 200 mg/d divided bid Children > 7 years*: 5 mg/kg/day div bid          10 days  

*Note: Daily dose in children should not exceed adult dose

Cunha CB.  The first atypical pneumonia: the history of the discovery of Mycoplasma pneumoniae.  Infect Dis Clin North Am 2010:24:1-5.


Mycoplasma pneumoniae