Mycoplasma pneumonia: Modern antibacterial therapy

Mycoplasma pneumoniae ( M. pneumoniae ) is one of the key pathogens causing the community-acquired pneumonia in all countries, especially in children and adolescents. Globally, M. pneumoniae infections occur in different regions of the world every 3–7 years and last 1–2 years. M. pneumoniae has infective factors characterized by high affinity to the epithelial cells of the respiratory tract, direct damaging effect, as well as ability to interact with immune system cells. The pathogenesis of mycoplasma infection, i.e. pneumonia, includes both direct damage and immune response mediated by vasculitis and thrombosis. Macrolides are used as the main class of antibiotics for the treatment of mycoplasma infection. They inhibit bacterial growth by binding to 23S rRNA and inhibiting protein synthesis. However, macrolide-resistant strains of M. pneumoniae (MRMP) have become widespread in Asia since 2000, accounting for about 80–90% infections in China and Japan today, at the same time, the detection rate of MRMP is very low in European countries and the US. Azithromycin and clarithromycin have high bioavailability, are stable at acidic pH, oral forms do not require intestinal coating. Instant soluble drug forms (azithromycin) and suspension can be used by patients regardless of food intake, which ensures convenience. While the slow released drug forms of azithromycin should be taken only on an empty stomach, the slow released extended forms of clarithromycin should be taken with food.