With drug resistance emerging as a serious concern and real-time surveillance still limited, the new framework signals a shift toward more responsible antibiotic use, accurate diagnostics, and timely intervention.
Published Oct 11, 2025 | 7:00 AM ⚊ Updated Oct 11, 2025 | 7:00 AM
Kerala State Technical Guidelines on the Diagnosis and Management of Mycoplasma Pneumoniae.
Synopsis: The Kerala government released its State Technical Guidelines on the Diagnosis and Management of Mycoplasma Pneumoniae, a move aimed at addressing the rising trend of the infection across the state. Officials said the framework will serve as a critical tool for healthcare providers in curbing outbreaks and safeguarding public health.
After more than a year of delay, the Kerala government finally released its State Technical Guidelines on the Diagnosis and Management of Mycoplasma Pneumoniae, a move aimed at addressing the rising trend of the infection across the state.
According to the state health department, the guidelines are designed to ensure effective control and management of the disease, with a strong focus on accurate diagnosis, preventive measures, and appropriate treatment protocols.
The timing of the guidelines comes amid growing concerns over drug resistance, particularly against azithromycin, the most commonly prescribed antibiotic for the infection.
Officials said the framework will serve as a critical tool for healthcare providers in curbing outbreaks and safeguarding public health.
Mycoplasma pneumoniae is a common bacterial cause of community-acquired pneumonia, often called “walking pneumonia” due to its usually mild course.
It primarily affects the respiratory system — throat, windpipe, and lungs — damaging the lining and causing infection.
Symptoms typically appear one to four weeks after exposure. The most frequent illness is tracheobronchitis, a chest cold, with signs such as a slowly worsening cough, sore throat, fatigue, fever, and headache.
In young children under five, the infection may resemble a common cold, with sneezing, runny nose, watery eyes, wheezing, vomiting, or diarrhoea.
The bacteria spread through tiny respiratory droplets when an infected person coughs or sneezes, and transmission is more likely among people living or working closely together.
School-aged children and young adults are most commonly affected, while pre-existing lung conditions like asthma can increase the risk of severe infection. While most cases are mild and self-limiting, antibiotics are reserved for more serious illnesses such as pneumonia.
Complications, though uncommon, can occur, especially in children and the elderly. Lung-related complications include acute respiratory distress syndrome, bronchiolitis obliterans, pleural effusion, and respiratory failure.
Extrapulmonary issues may affect the heart, brain, blood, skin, muscles, eyes, liver, pancreas, and kidneys, often due to the immune response triggered by the infection.
Awareness of Mycoplasma pneumoniae is important because, despite its often mild course, it can occasionally cause serious health problems. Early recognition, supportive care, and prompt medical attention in severe cases ensure recovery and prevent complications.
By practising cough hygiene, one can prevent the spread of disease to others.
The health department finalised and released guidelines for managing the respiratory infection, even as the state witnesses a falling trend in Mycoplasma pneumoniae infections, nearly a year after a spike was first detected.
Experts said that even though the guideline may appear delayed, it remains relevant, given continuous case reporting and the emergence of drug resistance.
Speaking to South First, a senior official with the state health department said, “The state had witnessed a spike in Mycoplasma pneumoniae cases last year. From August 2024 onwards, a rise was noted. This was not limited to Kerala alone; there was a global spike during the same period. The State Rapid Response Team decided to draw up a management guideline, and it was prepared and submitted last year itself.”
However, the official admitted that the guideline did not come out at the time when it was most needed.
“Now, in October — almost a year later — we finally have the guideline. While the number of cases is coming down, it’s still relevant as infections continue to be reported,” the official added.
A worrying trend is emerging in respiratory infections as Mycoplasma pneumoniae — a leading cause of atypical pneumonia — shows increasing resistance to azithromycin, a widely used macrolide antibiotic and has long been a first-line treatment for bacterial respiratory infections.
The increasing resistance has reduced its effectiveness globally, prompting public health authorities to act with caution.
“Mycoplasma is a genus of bacteria that lacks a cell wall, making it flexible and irregular in shape. Most antibiotics act by targeting the bacterial cell wall, but since mycoplasma doesn’t have one, many of them don’t work,” explained Dr Shajahan PS, Professor of Pulmonary Medicine at Government TD Medical College, Alappuzha, to South First.
“Azithromycin is one of the few antibiotics that’s usually effective against Mycoplasma. But because of our habit of using antibiotics without a doctor’s prescription — and the rampant over-the-counter use of azithromycin, especially during the Covid-19 pandemic — the bacteria have developed resistance,” he said.
Although Mycoplasma pneumoniae infections are typically mild and rarely lead to severe complications, Dr Shajahan warned that antibiotic misuse could make treatment increasingly challenging. “The key is to break the habit of using antibiotics without medical supervision,” he added.
Earlier, a study by doctors from the Department of Critical Care at Rajagiri Hospital, Aluva, published in the Indian Journal of Critical Care Medicine, noted that while overall mortality remained low, the number of patients requiring hospitalisation had risen.
The researchers suggested this may point to the emergence of new resistant or more virulent strains — warranting further genotypic studies.
Meanwhile, it turns out that Mycoplasma pneumoniae is not currently included in India’s Integrated Disease Surveillance Programme (IDSP), making real-time tracking difficult. Kerala identified the spike through data collected from molecular and public health laboratories.
Explaining the guideline, an official of the health department said, “Globally, studies including those from China have flagged rising azithromycin resistance. Normally, patients with Mycoplasma pneumoniae are treated with azithromycin. But with this resistance, it may not work effectively and could lead to complications. That’s why we have decided to sensitise healthcare providers.”
The guideline advises the use of doxycycline or other macrolides in prophylaxis and treatment where resistance is suspected. Under Kerala’s Antimicrobial Resistance Surveillance, several samples have already shown resistance to azithromycin.
Compared to Polymerase chain reaction (PCR) and IgM (Immunoglobulin M) serology, culture has shown low sensitivity and an extremely poor yield in detecting Mycoplasma pneumoniae.
Although culture was once considered the gold standard for diagnosis, the organism’s fastidious nature makes cultivation difficult and time-consuming, often requiring several weeks for growth. Serological tests are more convenient and sensitive than culture and have minimal pre-analytical requirements for sample collection and transport.
However, their turnaround time is typically longer, and false negatives are common in the early stages of illness. On the other hand, nucleic acid amplification tests (NAAT), such as PCR, offer rapid and sensitive results, even though these methods are not yet fully standardised.
Accurate and timely laboratory diagnosis of M. pneumoniae infection is essential — not just for clinical management but also for guiding appropriate antimicrobial use and supporting stewardship efforts.
Commonly submitted specimens include respiratory tract samples such as swabs, nasopharyngeal aspirates, sputum, or bronchoalveolar lavage. Other fluids like blood, cerebrospinal fluid (CSF), and joint aspirates may also be used for testing.
Confirming the shift in diagnostic approach, Dr Aravind Reghukumar, Head of the Department of Infectious Diseases at Government Medical College, Thiruvananthapuram, told South First, “According to the guidelines, culture is no longer recommended for diagnosing this pathogen and should be eliminated from routine practice. PCR or IgM serology will now be the preferred diagnostic option.”
The release of Kerala’s long-pending guideline on Mycoplasma pneumoniae — though delayed — marks an important step in strengthening clinical preparedness against a pathogen that has quietly but persistently challenged public health systems.
With drug resistance emerging as a serious concern and real-time surveillance still limited, the new framework signals a shift toward more responsible antibiotic use, accurate diagnostics, and timely intervention.
However, the real test will be how effectively these guidelines are implemented at the ground level — before the next spike hits.
(Edited by Muhammed Fazil.)
