第一选择
阿奇霉素
:
儿童:第一天 10 mg/kg,一天一次,之后5 mg/kg,一天一次, 连用4天;成人:第一天 500 mg,口服,一天一次, 250 mg,一天一次, 连用4天
或
克拉霉素
:
儿童: 15 mg/kg/天,分次给药,每 12 小时一次,最大剂量为 1000 mg/天;成人:500 mg,口服(速释型),一天两次
或
红霉素碱
:
儿童: 30-50 mg/kg/天,分次给药,每 6 小时一次;成人:500 mg,口服,一天四次
第二选择
多西环素
:
年龄 >8 岁的儿童:第一天 2.2 mg/kg,一天两次,之后 2.2 mg/kg,一天一次;成人:第一天,100 mg,口服,一天两次,之后 100 mg,一天两次
或
米诺环素
:
年龄 >8 岁的儿童:初始剂量 4 mg/kg,之后 2 mg/kg,一天两次;成人:初始剂量 200 mg,口服,之后 100 mg,一天两次
大多数支原体对大环内酯类(例如,阿奇霉素、克拉霉素和红霉素)敏感。因为治疗时通常还没有诊断出病原体,通常根据经验开始治疗。
可遵循相关的当地肺炎指南选择抗生素。
尽管亚洲已有大环内酯类耐药病例报道(高达 80%),但是其对呼吸道感染治疗仍有效。[52]Liu Y, Ye X, Zhang H, et al. Antimicrobial susceptibility of Mycoplasma pneumoniae isolates and molecular analysis of macrolide-resistant strains from Shanghai, China. Antimicrob Agents Chemother. 2009;53:2160-2162.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681541/http://www.ncbi.nlm.nih.gov/pubmed/19273684?tool=bestpractice.com[67]Suzuki S, Yamazaki T, Narita M, et al. Clinical evaluation of macrolide-resistant Mycoplasma pneumoniae. Antimicrob Agents Chemother. 2006;50:709-712.http://aac.asm.org/content/50/2/709.fullhttp://www.ncbi.nlm.nih.gov/pubmed/16436730?tool=bestpractice.com 中东( 30%),[53]Averbuch D, Hidalgo-Grass C, Moses AE, et al. Macrolide resistance in Mycoplasma pneumoniae, Israel, 2010. Emerg Infect Dis. 2011;17:1079-1082.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358208/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/21749775?tool=bestpractice.com欧洲( 10%),[21]Uldum SA, Bangsborg JM, Gahrn-Hansen B, et al. Epidemic of Mycoplasma pneumoniae infection in Denmark, 2010 and 2011. Euro Surveill. 2012;17:pii:20073.http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20073http://www.ncbi.nlm.nih.gov/pubmed/22321137?tool=bestpractice.com[54]Peuchant O, Ménard A, Renaudin H, et al. Increased macrolide resistance of Mycoplasma pneumoniae in France directly detected in clinical specimens by real-time PCR and melting curve analysis. J Antimicrob Chemother. 2009;64:52-58.http://jac.oxfordjournals.org/cgi/content/full/64/1/52?view=long&pmid=19429926http://www.ncbi.nlm.nih.gov/pubmed/19429926?tool=bestpractice.com[55]Spuesens EB, Meijer A, Bierschenk D, et al. Macrolide resistance determination and
molecular typing of Mycoplasma pneumoniae in respiratory specimens collected
between 1997 and 2008 in the Netherlands. J Clin Microbiol. 2012;50:1999-2004.http://www.ncbi.nlm.nih.gov/pubmed/22495561?tool=bestpractice.com及美国(10%)。[56]Diaz MH, Benitez AJ, Winchell JM. Investigations of Mycoplasma pneumoniae infections in the United States: trends in molecular typing and macrolide resistance from 2006 to 2013. J Clin Microbiol. 2015;53:124-130.http://www.ncbi.nlm.nih.gov/pubmed/25355769?tool=bestpractice.com[57]Yamada M, Buller R, Bledsoe S, et al. Rising rates of macrolide-resistant
Mycoplasma pneumoniae in the central United States. Pediatr Infect Dis J. 2012;31:409-411.http://www.ncbi.nlm.nih.gov/pubmed/22209916?tool=bestpractice.com肺炎支原体也对四环素类(例如,多西环素和米诺环素)敏感。
疗程取决于所发生感染的类型。在对大环内酯类耐药的肺炎支原体患病率较高的国家,四环素类(多西环素或米诺环素)可能比大环内酯类或喹诺酮类的效果更好。[58]Okada T, Morozumi M, Tajima T, et al. Rapid effectiveness of minocycline or doxycycline against macrolide-resistant Mycoplasma pneumoniae infection in a 2011 outbreak among
Japanese children. Clin Infect Dis. 2012;55:1642-1649.http://www.ncbi.nlm.nih.gov/pubmed/22972867?tool=bestpractice.com[59]Kawai Y, Miyashita N, Kubo M, et al. Therapeutic efficacy of macrolides, minocycline, and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae pneumonia in pediatric patients. Antimicrob Agents Chemother. 2013;57:2252-2258.http://www.ncbi.nlm.nih.gov/pubmed/23459497?tool=bestpractice.com