Am surprised that you could compile such a list. I assumed that because mycoplasma infections (except for pneumonia) were so poorly understood, that no one would have done enough research to know which antibiotics worked for which species. What was your source for this information?

The only things I have been able to find are:

1. Ketek technical description lists M. pneumoniae, but no other mycoplasma as being studied. Important to me because every other drug on your list for fermentans is in the quinolone group and I can't use those after tendon damage from avelox.

I had looked at the info at IMMED and it was saying that doxy and mino were the best according to their research. They did say however that abx needed to be rotated every 6 months. I wonder if that is this study of doxy failed, or if it is just not effective for myco's.

That's exactly why I wanted to put this out here. Finding and compiling this information was not easy. But it does appear that some research has/is being done.

Below is one study on Ketek and mycoplasmas that I found in Antimicrobial Agents and Chemotherapy.

Doxycycline does work against mycoplasma fermentans but most articles state that it is not as effective (i.e. takes a much larger dose) than the antibiotics that are listed. It also is bacteriostatic, whereas the quinolones are more bactericidal.

This article reports fairly good activity with Doxycycline.

My personal experience is that Doxy is not effective. I was on as much as 400 mg/d and it did next to nothing for me.

Ketek, Cipro and Factive have really helped.

Comparative Activities of Telithromycin (HMR 3647), Levofloxacin, and Other Antimicrobial Agents against Human Mycoplasmas
C. M. Bebear,1,* H. Renaudin,1 A. Bryskier,2 and C. Bebear1
Laboratoire de Bact�riologie, Universit� Victor Segalen Bordeaux 2, 33076 Bordeaux Cedex,1 and Hoechst Marion Roussel, 93235 Romainville Cedex,2 France

Received 8 December 1999/Returned for modification 25 March 2000/Accepted 11 April 2000

ABSTRACT
The activities of telithromycin and levofloxacin against 99 mycoplasma strains were compared to those of several macrolides, ofloxacin, and doxycycline. Telithromycin MICs of 0.25 �g/ml were found for all isolates, except for Mycoplasma hominis, while levofloxacin was active at concentrations of 1 �g/ml against all species studied.

TEXT
Only a few classes of antimicrobial agents are available for the treatment of mycoplasmal infections in humans. They are mainly the tetracyclines, macrolides, and fluoroquinolones (15). Resistance to tetracyclines by the acquisition of the tetM gene has been frequently described for urogenital mycoplasmas (12, 13). Concerning macrolides, Mycoplasma hominis and Mycoplasma fermentans are innately resistant to erythromycin but not to josamycin, while Mycoplasma pneumoniae and Mycoplasma genitalium are very susceptible to all these antibiotics. The newest macrolides are semisynthetic compounds known as ketolides (6). They have improved activity against microorganisms resistant to macrolides, especially gram-positive bacteria (8). One of them is telithromycin (HMR 3647), an erythromycin A derivative. Newer fluoroquinolones with enhanced activity against gram-positive bacteria and intracellular organisms have been developed (9). Levofloxacin, the l-isomer of ofloxacin, is one of these (10, 14).

In this study, we compared the in vitro activity of telithromycin to those of several macrolides, including erythromycin A, roxithromycin, dirithromycin, clarithromycin, azithromycin, josamycin, and spiramycin, and the in vitro activity of levofloxacin to that of ofloxacin against clinical and reference strains of different human mycoplasma species. Doxycycline was used as a reference compound. Each of the following antimicrobial agents was provided by the manufacturer: telithromycin, levofloxacin, erythromycin A, roxithromycin, and ofloxacin (Hoechst Marion Roussel, Romainville, France); azithromycin and doxycycline (Pfizer, Orsay, France); clarithromycin (Abbott, Rungis, France); dirithromycin (Lilly France, Saint Cloud, France); and josamycin and spiramycin (Rh�ne-Poulenc-Rorer, Vitry-sur-Seine, France).

Ninety-nine strains, including 25 strains of M. pneumoniae (24 clinical respiratory isolates and 1 reference strain [FH]), 5 strains of M. genitalium (4 clinical isolates and 1 reference strain [G37]), 32 strains of M. hominis (29 josamycin-susceptible clinical isolates, 2 josamycin-resistant clinical isolates, and 1 reference strain [PG21]), 5 strains of M. fermentans (4 clinical isolates and 1 reference strain [PG18]), 2 strains of Mycoplasma penetrans (1 urethral isolate and 1 reference strain [GTU-54]), 15 Ureaplasma urealyticum doxycycline-susceptible strains (14 clinical isolates and 1 reference strain, serotype 8), and 15 U. urealyticum doxycycline-resistant strains (14 clinical isolates and 1 reference strain, serotype 9), were studied.

Susceptibility testing was carried out as previously described (1) by an agar dilution method with Hayflick modified agar for mycoplasmal strains and by a broth dilution method with Shepard medium for ureaplasmal strains. Minimal bactericidal concentrations (MBCs) of the different compounds were determined as previously reported (3) for a reference strain of each species.

The in vitro activities of telithromycin, levofloxacin, and other antimicrobial agents are shown in Table 1. Telithromycin inhibited all mycoplasmal and ureaplasmal strains, except for M. hominis, at 0.25 �g/ml. Telithromycin shared the best activity (MIC at which 90% of strains were inhibited [MIC90] or MIC range, 0.015 �g/ml) with erythromycin A, roxithromycin, clarithromycin, and azithromycin against M. pneumoniae isolates and with erythromycin A and roxithromycin against M. genitalium isolates. Telithromycin had the lowest MIC range, from 0.06 to 0.25 �g/ml, against both M. fermentans and M. penetrans. Against M. hominis isolates for which josamycin was the only active macrolide, telithromycin had a high MIC90 (16 �g/ml), but this MIC90 was fourfold lower than those of the macrolides, except for josamycin. However, the two josamycin-resistant clinical isolates of M. hominis previously described (5) were found to be as resistant to telithromycin as to the macrolides (MIC, >128 �g/ml).

Against U. urealyticum strains, telithromycin was found to be as active as clarithromycin, the most active macrolide tested, with an MIC90 of 0.03 �g/ml. Furthermore, ketolide activity was the same whatever the doxycycline susceptibility profile of the ureaplasmal isolates. Our study on telithromycin globally confirms our results previously reported for other ketolides, such as RU 004, RU 306, RU 469, and RU 399, for mycoplasmas, with MICs ranking in similar ranges (2).

The MBCs of telithromycin were found to be close to the MICs for M. pneumoniae and M. genitalium (MBCs, 0.12 �g/ml), as were the MBCs of the macrolides tested. Against M. fermentans and M. penetrans, the telithromycin MBCs were found to be 2 and 1 �g/ml, respectively, much lower than those of the macrolides, especially for M. fermentans (MBCs of comparative macrolides, 16 to >128 �g/ml). Against M. hominis, the telithromycin MBC (16 �g/ml) was comparable to that of josamycin, the only macrolide that had low MICs against this species. Against U. urealyticum, despite a very low MIC90, telithromycin did not have good bactericidal activity, with an MBC of 32 �g/ml. Only two macrolides, clarithromycin and azithromycin, had lower MBCs, between 1 and 8 �g/ml. In summary, except against M. hominis and U. urealyticum, telithromycin was bactericidal against mycoplasmal isolates.

Comparative results for levofloxacin are also shown in Table 1. All the mycoplasma strains studied were inhibited by 1 �g of levofloxacin per ml. Against the five mycoplasma species studied, levofloxacin had activity similar to that of ofloxacin, with equal MICs for M. pneumoniae and M. genitalium (MIC range, 0.5 to 1 �g/ml) or an MIC twofold lower for M. hominis, M. fermentans, and M. penetrans. Against U. urealyticum, levofloxacin was two- to fourfold more active than ofloxacin (MIC90, 0.5 to 1 �g/ml), with similar activity against doxycycline-susceptible or -resistant strains. In a previous study, Ullmann et al. (16) obtained results within the same range as ours for levofloxacin against U. urealyticum but not against M. hominis, for which they found an MIC90 fourfold higher. Waites et al. (17) found the same MIC90 of levofloxacin as we did against M. hominis by the E test method (17). It should be noted that levofloxacin showed only slightly enhanced activity against mycoplasmas in comparison to ofloxacin, with MICs only one dilution higher. In terms of in vitro activity, levofloxacin does not seem to be significantly more active than its l-isomer, ofloxacin, against mycoplasmas.

For all mycoplasmal and ureaplasmal strains, MBCs of levofloxacin were equal to or twofold lower than those of ofloxacin, ranging from 0.12 �g/ml against M. penetrans to 4 �g/ml against M. genitalium and M. hominis. For M. pneumoniae, M. genitalium, M. penetrans, and U. urealyticum, MBCs were only 2- to 4-fold higher than MICs, while they were 8- to 16-fold higher than MICs for M. hominis and M. fermentans. However, levofloxacin seemed to be bactericidal in vitro against mycoplasmas, with MBCs of 4 �g/ml.

As a reference compound, doxycycline showed good activity, ranging between those of telithromycin and levofloxacin, against mycoplasmas and U. urealyticum doxycycline-susceptible strains (MICs, 0.03 to 0.25 �g/ml), except for M. hominis strains, some of which were doxycycline resistant.

In conclusion, our data suggest that levofloxacin, like other new fluoroquinolones (3, 4, 7, 11, 16), may be interesting for the treatment of respiratory and urogenital mycoplasma infections. Telithromycin, belonging to the new class, ketolides, seems to be very effective against mycoplasmas, except for M. hominis, and could have useful clinical activity against these microorganisms.

I am very interested in the information you dug up, Matthias. Cheryl on Lymeinfo website was looking for mycoplasma in ticks info, so maybe she might want to put your study, including references on her website.

It does look like there are antibiotics being used for diseases such as the rheumatic type of arthritis, without knowing exactly why they help. Have you seen this website? http://www.cfsresearch.org/mycoplasma/publications/treatment/index2.htm

Also, apparently other drugs are being used that are not on your list, empiric treatment I guess you would call it, as Lisa posted.

Since so many people are carrying mycoplasma around as a gut commensal, why does it sometimes turn into a villain, appearing in the spinal fluid and blood? Did we get mycoplasma infections from the tick bite or was it opportunistic, somehow getting its chance when the tick-borne infections were introduced into our bodies?

Got to say that it makes my head swim, trying to understand/figure this out.

Wonder why they used doxy in the Gulf War study? Afraid of the quinolones, and ketek had not been approved yet? Of course, if the mycoplasma in these people was opportunistic, triggered by something else or several things, like chemicals, vaccines, etc., then treatment for mycoplasma alone might not work, even if they used the right drug.

I personally have trouble with the concept of treating a disease for X amount of time and then concluding that it doesn't work. If you treated AIDS or TB with a week or a month of one drug, would these people be cured? No. And it wouldn't prove that treatment didn't work. Only that the correct treatment had not been found.

Seems to me, also, that the medical establishment is looking to simplify things too much, with research controlling variables to an extent not mirrored in the actual human beings.

When several things are going on at once, it gets very complicated. And the typical doc or academic MD easily becomes overwhelmed and just goes with the cookbook.

Look at the malaria thread, which I think is trying to explain treatment and diagnosis failures in babesia by saying that it could really be malaria. And some types of malaria need treatment for the stage outside the RBC or they just keep recurring. Some of us are not testing positive for babesia because they aren't looking for every species/strain out there. And it just seems logical that babesia could also have an exoerythocytic stage, and that could account for the long time it has taken for some people to get rid of babesia.

In other words, not necessary to have malaria to account for the babesia testing and treatment failures. But some people in this country probably do have undetected malaria.

See how complicated this all is? No wonder we are having such problems. It isn't just Lyme, but all this other stuff that muddies the water. Mind boggling.

I did have a PCR test. But the Neuro who ordered it only put Lyme down on the Rx. So, I didn't get all the tests that I was expecting. The blood test seems pretty telling in my case.

Also, during my PCR the technician accidentally hit the nerve that goes to my bladder, shutting down my urinary capabilities for hours. I ended up in the ER with urine backed up to my eyeballs. I am not ready to do another PCR any time soon. I am too chicken!

Do you think the PCR is better, if it already shows up in my blood?

The lab that did the PCR was MDL in NJ.

I don't know if a PCR is better but they can try to determine how much bacteria that you still have. Also would rule out if you have multiple strains.

I had an antibody cross reaction between Mycoplasma pneumoniae and Mycoplasma fermentans. I was testing IgM and IgG positive for M. pneumoniae but I really had M. fermentans. The fact that Zithromax is helping you leads me to believe that you do have M. pneumoniae. It did nothing for me.

robi,

I noticedit said not to use factive with low Mg levels. Don't we all have low Mg levels?

I know that Factive adsorption is affected by magnesium supplements but so are a lot of abx. I space my supplements and abx dosages out.

I guess you would have to ask your LLMD if that is a show stopper or not. Apparently it wasn't for me.

Factive
Active Ingredients: Gemifloxacin mesylate
Representative Names: Factive

What are Gemifloxacin tablets?
What should my health care professional know before I receive Gemifloxacin?
How should this medicine be used?
What if I miss a dose?
What drug(s) may interact with Gemifloxacin?
What side effects may I notice from receiving Gemifloxacin?
What should I watch for while taking Gemifloxacin?
Where can I keep my medicine?

What are Gemifloxacin tablets? (Back to top)
GEMIFLOXACIN (Factive�) is an antibacterial agent. It kills certain bacteria or stops their growth. It is used to treat bronchitis and pneumonia. Generic gemifloxacin tablets are not yet available.

What should my health care professional know before I receive Gemifloxacin? (Back to top)
They need to know if you have any of these conditions:
*diabetes
*heart disease, slow heart beat, recent heart attack
*liver or kidney disease
*long exposure to sunlight (working outdoors)
*low potassium or magnesium levels
*seizures (convulsions)
*stomach problems (especially colitis)
*stroke
*other chronic conditions
*an unusual reaction to Gemifloxacin, other fluoroquinolone antibiotics, medicines, foods, dyes, or preservatives
*pregnant or trying to get pregnant
*breast-feeding

How should this medicine be used? (Back to top)
Take gemifloxacin tablets by mouth with or without food. Follow the directions on the prescription label. Swallow tablets whole with a full glass of water. Take your doses at regular intervals. Do not take your medicine more often than directed. Finish the full course prescribed by your prescriber or health care professional even if you think your condition is better. Do not stop taking except on your prescriber's advice.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What if I miss a dose? (Back to top)
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What drug(s) may interact with Gemifloxacin? (Back to top)
*aluminum salts
*antacids
*arsenic trioxide
*astemizole
*bepridil
*certain medicines to control the heart rhythm (e.g., amiodarone, disopyramide, dofetilide, flecainide, ibutilide, quinidine, procainamide, propafenone, sotalol)
*certain medicines for depression or mental problems (e.g., amoxapine, haloperidol, maprotiline, phenothiazines, risperidone, sertindole, ziprasidone)
*cisapride
*clarithromycin
*cyclobenzaprine
*didanosine (ddI)
*dolasetron
*droperidol
*erythromycin
*levomethadyl
*iron (ferrous sulfate) preparations
*magnesium salicylate
*magnesium salts
*manganese
*multivitamins containing iron, manganese, or zinc
*NSAIDs such as Advil�, Aleve�, ibuprofen, Motrin�, naproxen
*pentamidine
*probenecid
*probucol
*quinapril
*retinoid products such as tretinoin (Retin-A�, Renova�) or isotretinoin (Accutan�)
*sevelamer
*sucralfate
*terfenadine
*troleandomycin
*zinc salts

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What side effects may I notice from receiving Gemifloxacin? (Back to top)
Side effects that you should report to your prescriber or health care professional as soon as possible:
Rare or uncommon:
*confusion
*difficulty breathing
*irregular heartbeat, palpitations or chest pain
*joint, muscle or tendon pain
*numbness or tingling in hands or feet
*redness, blistering, peeling or loosening of the skin, including inside the mouth
*seizures
*severe or watery diarrhea
*skin rash, itching
*swelling of the face or neck
*tremor or restlessness
*unusual tiredness or weakness
*vomiting

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
*mild diarrhea
*dizziness
*headache
*nausea or stomach upset
*taste disturbance

What should I watch for while taking Gemifloxacin? (Back to top)
Tell your prescriber or health care professional if your symptoms do not improve in 2 to 3 days. If you get an unusual reaction stop taking gemifloxacin and call your prescriber or health care professional for advice.

If you are a diabetic, monitor your blood glucose carefully while on this medicine. Contact your healthcare professional immediately if there are significant changes in your blood sugar.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how gemifloxacin affects you. To reduce the risk of dizzy or fainting spells, do not sit or stand up quickly, especially if you are an older patient.

Many antacids and multivitamins can interfere with absorption of gemifloxacin. This may stop gemifloxacin from working. Make sure it has been at least 3 hours since you last took gemifloxacin before taking any of these products.

Keep out of the sun, or wear protective clothing outdoors and use a sunscreen. Do not use sun lamps or sun tanning beds or booths.

If you notice pain or swelling of a tendon or around a joint, stop taking gemifloxacin. Rest the affected area and call your healthcare provider. Do not exercise or resume taking gemifloxacin until your healthcare provider tells you to do so.

If you are going to have surgery, tell your prescriber or health care professional that you are taking gemifloxacin.

Where can I keep my medicine? (Back to top)
Keep out of the reach of children in a container that small children cannot open.

Mathias,
I have been on Ketek for almost 4 months. I am feeling some better but who knows whih supplement or med is helping.

I have always had a hard time sorting all this out.