Empiric Antibiotic Therapy for <i>Mycoplasma pneumoniae</i> Pneumonia in Children: A Pro/Con Discussion

Mycoplasma pneumoniae is a common respiratory pathogen of increasing clinical interest due to a recent rise in cases in the United States and worldwide following a period of reduced activity during the COVID-19 pandemic. While most cases are mild, M pneumoniae can cause severe community-acquired pneumonia (CAP), and cannot be reliably distinguished from other common causes of CAP based solely on features of clinical presentation or imaging. However, testing to confirm a diagnosis of M pneumoniae, when it is suspected, can be logistically challenging in some clinical settings. It also remains unclear which patients with M pneumoniae CAP benefit from antibiotic treatment, which raises the question of whether treatment should be offered, particularly when the diagnosis is not confirmed. This pro/con discussion explores the available data to support or refute routine testing and empiric antibiotic treatment for M pneumoniae.