Coughing Nonstop? It Turns Out Mycoplasma Pneumonia Is to Blame!
Update Date：2024/11/05，
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Pharmacist Wang Hsiao-Ping from the Clinical Pharmacy Department.
Recently, there seems to be an increasing number of patients suffering from mycoplasma pneumonia infections. What initially appears to be a simple cold often turns into a persistent cough that does not improve, leading patients to see doctors multiple times before finally confirming it as a mycoplasma infection.
The symptoms of mycoplasma pneumonia are similar to those of other upper respiratory infections, such as the common cold or influenza, making it difficult for healthcare providers to distinguish between them in the early stages of the disease. Additionally, the presence of antibiotic-resistant strains can result in delays in diagnosis and treatment.
Even after receiving treatment, patients may continue to cough for several weeks during their recovery process. If the patient is a child, parents may not only worry about their child's recovery but also how the illness could impact their daily life and learning. Ineffective treatment may lead to severe complications like pneumonia, asthma exacerbation, or skin rashes, requiring additional medical care.
According to a 2018 epidemiological study on pneumonia in Taiwan, Mycoplasma pneumoniae is one of the five most common pathogens causing community-acquired pneumonia in the country, with a notably higher incidence rate (23%-37%) among children under 19 compared to Western countries. Mycoplasma pneumonia can occur year-round, but it is particularly prevalent from late summer to early autumn.
Transmission primarily occurs through respiratory droplets, with an incubation period of about 1 to 4 weeks. Common clinical symptoms include sore throat, fatigue, fever, headache, and cough, with the cough typically being dry and potentially lasting for weeks or even months. Children under 5 years old may have fewer instances of fever but may exhibit symptoms such as wheezing, vomiting, or diarrhea.
In the past, macrolide antibiotics were the first-line treatment for Mycoplasma pneumoniae infections. However, recent studies have shown an increasing trend of antibiotic-resistant Mycoplasma pneumoniae, particularly in Asia. In this context, tetracycline antibiotics (such as doxycycline) or fluoroquinolone antibiotics (such as levofloxacin) have emerged as alternative options.
The 2018 pneumonia treatment guidelines in Taiwan recommend doxycycline or minocycline as the first-line treatment for adults with Mycoplasma pneumoniae infections, with a suggested treatment duration of 7 to 14 days. For children, macrolide antibiotics remain the first choice. However, if a child continues to have a fever after 48 to 72 hours of treatment or if chest X-rays show signs of worsening pneumonia, consideration should be given to the significant rise in antibiotic resistance among Mycoplasma pneumoniae in pediatric populations. In such cases, doxycycline or levofloxacin may be considered as alternative treatments based on the child's age and the severity of the condition.
It has long been known that tetracycline antibiotics, such as tetracycline itself, can cause discoloration of tooth enamel, leading to a contraindication for use in children under eight years old. However, recent studies have shown that short-term use of doxycycline, a member of the tetracycline class, does not result in tooth enamel staining in pediatric populations.
Due to its acidic propertie, doxycycline should be taken with at least 240 milliliters of water, and patients are advised to remain in an upright position for at least 30 minutes after taking the medication to facilitate its passage through the esophagus. This practice helps minimize irritation to the esophageal mucosa and reduces the risk of ulceration.
For optimal absorption, doxycycline is best taken on an empty stomach, either one hour before meals or two hours after. However, if taking it on an empty stomach causes gastrointestinal discomfort, it can be taken with food, provided that dairy products are avoided. This is because calcium and other metal ions, such as magnesium, zinc, aluminum, and iron, found in dairy can form insoluble chelates with doxycycline, reducing its absorption and effectiveness. This can affect its efficacy. It is recommended to separate the intake of doxycycline and these metal ions by 2 to 3 hours to minimize interactions.
Levofloxacin may have adverse effects on the developing bones, joints, and tendons of children. As a result, Taiwan's Ministry of Health and Welfare has not approved its use in individuals under 18 years of age. However, in special circumstances, such as severe or complicated infections or when other antibiotics are ineffective or there is a presence of resistant strains, levofloxacin may still be considered for use in children.
During treatment with levofloxacin, it is important to maintain adequate hydration to reduce the risk of crystalluria. It should be taken at least 2 hours apart from antacids or supplements containing metal ions such as magnesium, aluminum, calcium, zinc, and iron to avoid interference with the absorption of levofloxacin. Levofloxacin can be taken on an empty stomach or with food, but it is recommended to avoid simultaneous consumption with calcium-rich dairy products whenever possible.
Currently, there is no vaccine available to prevent Mycoplasma pneumoniae infections. When infected, it is important to use appropriate antibiotics and complete the prescribed treatment course to reduce the development of antibiotic-resistant strains.
The public should also pay attention to personal hygiene practices. When experiencing respiratory symptoms (especially coughing), it is essential to wear a mask. When coughing or sneezing, cover the mouth and nose with a tissue and dispose of it immediately. If a tissue is not available, use the upper arm or elbow instead, avoiding direct contact with hands. Regular handwashing is crucial; hands should be scrubbed with soap for at least 20 seconds. When water is not available, hand sanitizers or 75% alcohol can be used as an alternative to soap and water for cleaning hands.