Managing Mycoplasma Infection: Treatment Duration and Medication Guidance

Medication issues related to suspected Mycoplasma infections?

Hello Dr.
Liao,
I started experiencing symptoms of a sore throat, itching, and coughing on March 19 while in mainland China.
Due to potential exposure to a Mycoplasma infection, I sought medical attention after returning to Taiwan on March 28.
Initially, I took CURAM and Daypro for three days, which provided some relief, but after three days, my cough returned.
I did not have a runny nose or fever.
Five days ago, I began taking Moxifloxacin 100 mg every 12 hours.
I have been on this treatment for a week, and there has been significant improvement; my cough is easier, and I am able to expel more phlegm (previously it was white and sticky, but it has turned slightly yellow in the past two days).

Although I feel better, I still cough for a while when lying down at night and also cough a bit in the morning upon waking.
I have been taking Pantoprazole as a PPI.

I would like to ask for your advice.
I suspect that because my condition has persisted for a longer time, the Mycoplasma load may be higher.
Given my current situation, should I stop taking Moxifloxacin after seven days, or should I continue for three more days (according to the guidelines, it can be taken for 7-10 days)? Would it be better to take it for a full 10 days? Thank you, Mr.
Du.

Mr. Du, 60~69 year old female. Ask Date: 2024/04/10

Dr. Liao Zhongxin reply Internal Medicine

According to the recommendations from the Centers for Disease Control in Taiwan:
1.
The drug of choice for Mycoplasma pneumoniae is not erythromycin, but rather macrolide antibiotics.
Alternative medications include fluoroquinolone antibiotics or tetracycline antibiotics.
Generally, symptoms caused by Mycoplasma pneumoniae are mild, and most infected individuals can recover without antibiotic treatment.
However, if pneumonia develops, physicians typically prescribe antibiotics, as early intervention can expedite patient recovery.
2.
Since Mycoplasma pneumoniae lacks a cell wall, many common antibiotics, such as beta-lactam antibiotics, are ineffective against it.
3.
The recommended first-line treatment is macrolide antibiotics, with fluoroquinolones or tetracyclines as alternative options.
However, recent studies from various countries indicate an increase in macrolide resistance among Mycoplasma pneumoniae, although there is no significant difference in disease severity.
4.
For patients suspected of having Mycoplasma pneumoniae infection who require antibiotic treatment, it is advised to consider their age and the severity of clinical manifestations.
Clinicians should refer to the "Taiwan Guidelines for the Diagnosis and Treatment of Pneumonia" published by the Taiwan Society of Infectious Diseases and the Taiwan Society of Pulmonary and Critical Care Medicine, as well as the "Guidelines for the Management of Pediatric Community-Acquired Pneumonia" from the Taiwan Pediatric Infectious Disease Society.
Patients should adhere to proper antibiotic usage guidelines, avoiding the self-purchase of antibiotics from pharmacies, and strictly follow the physician's instructions regarding the prescribed dosage and duration of antibiotic therapy.

Last updated on November 13, 2023.

Reply Date: 2024/04/10

More Info

Dear Mr. Du,
Thank you for your inquiry regarding the management of Mycoplasma infection and the treatment duration for your current condition. Based on the information you've provided, it seems that you have been experiencing symptoms consistent with a Mycoplasma infection, and you have already undergone treatment with CURAM and subsequently with doxycycline.
Mycoplasma pneumoniae is a common cause of respiratory infections, particularly in younger populations. It is known for causing atypical pneumonia, which often presents with symptoms such as a persistent cough, sore throat, and sometimes fever. The treatment of choice for Mycoplasma infections typically includes antibiotics such as doxycycline, azithromycin, or fluoroquinolones, depending on the patient's age and any potential contraindications.

In your case, you have been taking doxycycline for about a week, and you are noticing significant improvement in your symptoms, which is a positive sign. The presence of yellow sputum indicates that your body is likely fighting off the infection, as this can be a sign of the immune response to bacterial infection.
Regarding the duration of doxycycline treatment, the general recommendation for treating Mycoplasma pneumoniae infections is typically between 7 to 14 days. While you mentioned the possibility of stopping the medication after 7 days, it is generally advisable to complete a full course of antibiotics to ensure that the infection is fully eradicated, especially since you initially experienced a resurgence of symptoms after your first treatment.
If you are feeling significantly better and your cough is lessening, it may be tempting to stop the medication early. However, I would recommend continuing doxycycline for a total of 10 days, as this aligns with the guidelines and helps to prevent the risk of relapse or the development of antibiotic resistance.
Additionally, since you are experiencing nighttime cough and morning cough, it may be beneficial to consider other supportive measures. Elevating your head while sleeping can help reduce nighttime coughing, and using a humidifier may also provide relief by keeping your airways moist.
As for the use of PPI (proton pump inhibitors) like esomeprazole, it is important to monitor for any gastrointestinal side effects, as antibiotics can sometimes disrupt the normal gut flora, leading to issues such as diarrhea or abdominal discomfort. If you experience any severe side effects or if your symptoms do not improve, it is crucial to follow up with your healthcare provider for further evaluation.

In summary, I recommend continuing doxycycline for a total of 10 days to ensure complete resolution of the infection. Monitor your symptoms closely, and if you have any concerns or if your condition worsens, do not hesitate to seek medical attention.
Wishing you a speedy recovery!
Best regards,
Doctor Q&A Teams

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