Journal of Antimicrobial Chemotherapy, Vol 40, 622-630, Copyright © 1997 by The British Society for Antimicrobial Chemotherapy
D Taylor-Robinson and C Bebear
Mycoplasmas are the smallest free-living microorganisms, being about 300 nm
in diameter. They are bounded by a triple-layered membrane and, unlike
conventional bacteria, do not have a rigid cell wall. Hence, they are not
susceptible to penicillins and other antibiotics that act on this
structure. They are, however, susceptible to a variety of other
broad-spectrum antibiotics, most of which only inhibit their multiplication
and do not kill them. The tetracyclines have always been in the forefront
of antibiotic usage, particularly for genital tract infections, but
macrolides are also widely used for respiratory tract infections. Indeed,
in comparison with the tetracyclines, erythromycin, the newer macrolides,
the ketolides and the newer quinolones have equal or sometimes greater
activity. The two latter antibiotic groups also have some cidal activity.
The antibiotic susceptibility profiles of several mycoplasmas of human
origin are presented, those of Mycoplasma pneumoniae and Mycoplasma
genitalium being similar. Apart from the penicillins, mycoplasmas are
innately resistant to some other antibiotics, for example the rifampicins.
In addition, some may develop resistance, either by gene mutation or by
acquisition of a resistance gene, to antibiotics to which they are usually
sensitive. Resistance of mycoplasmas to tetracyclines is common and due to
acquisition of the tetM gene. The antibiotic susceptibility pattern may be
influenced greatly by the source of the mycoplasma; for example, one
recovered from a contaminated eukaryotic cell culture that has been
subjected to extensive antibiotic treatment may have an antibiotic profile
quite different from the same mycoplasmal species that has been recovered
directly from a human or animal source. Mycoplasmas may be difficult to
eradicate from human or animal hosts or from cell cultures by antibiotic
treatment because of resistance to the antibiotic, or because it lacks
cidal activity, or because there is invasion of eukaryotic cells by some
mycoplasmas. Eradication may be particularly difficult in immunosuppressed
or immunodeficient individuals, particularly those who are
hypogammaglobulinaemic. The regimes that are most likely to be effective in
the treatment of respiratory or genitourinary mycoplasmal infections are
presented.
REVIEWS
Antibiotic susceptibilities of mycoplasmas and treatment of mycoplasmal infections
Department of Genitourinary Medicine, Imperial College School of Medicine at St Mary's, Paddington, London, UK.
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