Correct!
2. Begin macrolide antibiotics
Macrolides (e.g., azithromycin) are generally considered the treatment of choice for mycoplasma in both children and adults (1). In addition to macrolides, fluoroquinolones are recommended for the treatment of adults and tetracyclines (e.g., doxycycline) can be used for older children and adults. All mycoplasmas lack a cell wall and, therefore, all are inherently resistant to beta-lactam antibiotics (e.g., penicillin). Resistance to macrolides has been emerging in Mycoplasma since 2000. Current data suggest that the prevalence of macrolide resistance in M. pneumoniae is probably rising in the United States, possibly due to increased use of azithromycin in recent years to treat a number of illnesses.
The patient does not have classic pneumonia but has bronchiolitis, an inflammatory process of small airways (< 2 mm). Although this is most commonly seen in children secondary to viral infection, adults may also develop broncholitis. Possible causes in adults include inhalational injury, infection, drug-induced, connective tissue disease, graft vs. host disease, ulcerative colitis, primary biliary cirrhosis and idiopathic (2). This patient is rather typical in both clinical and radiographic appearance for broncholitis.
Although classically associated with pneumonia, Mycoplasma may also case a broncholitis picture (3). In the series reported by Cha (3), 27% of cases of Mycoplasma infection showed this pattern. Nasopharnygeal swab PCR has limited sensitivity for Mycoplasma infections (40%) similar to the results in this patient. Overall the prognosis is good, although some patients with residual restrictive changes have been reported. Our patient responded rapidly to macrolide antibiotic therapy.
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