Clinical Efficacy of Doxycycline for Treatment of Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Children.

Hyunju Lee,Jae Hong Choi,Eun Young Cho,Mi Seon Han,Youn Young Choi,Ji Young Park,Kyungmin Kim,Ye Kyung Kim,Young Joo Sohn,Ki Wook Yun,Eun Hwa Choi

doi:10.3390/antibiotics10020192

Abstract

In areas with high prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia, treatment in children has become challenging. This study aimed to analyze the efficacy of macrolides and doxycycline with regard to the presence of macrolide resistance. We analyzed children with MP pneumonia during the two recent epidemics of 2014–2015 and 2019–2020 from four hospitals in Korea. Nasopharyngeal samples were obtained from children with pneumonia for MP cultures and polymerase chain reaction (PCR). Macrolide resistance was determined by the analysis of 23S rRNA gene transition. Time to defervescence and to chest X-ray improvement were analyzed. Of 145 cases, the median age was 5.0 years and MRMP accounted for 59 (40.7%). Among macrolide-susceptible MP (MSMP), 78 (90.7%) were treated with macrolides and 21 (35.6%) in the MRMP group with doxycycline. In MRMP pneumonia, shorter days to defervescence (2 vs. 5 days, p < 0.001) and to chest X-ray improvement (3 vs. 6 days, p < 0.001) in the doxycycline group than in the macrolide group was observed, whereas no differences were observed among children with MSMP pneumonia. Compared to macrolides, treatment with doxycycline resulted in better outcomes with a shorter time to defervescence and to chest X-ray improvement among children with MRMP pneumonia.

Highlights

Antibiotics that act on the bacterial ribosome and inhibit protein synthesis such as macrolides or tetracyclines or agents that inhibit DNA replication such as fluoroquinolones are active against Mycoplasma pneumoniae (MP) [6,7]
macrolide-susceptible MP (MSMP), macrolide-susceptible Mycoplasma pneumoniae; MRMP, macrolide-resistant Mycoplasma pneumoniae, * Comparison between three groups, † MSMP vs. MRMP; Data are median (IQR); Duration of fever was defined as days of fever after initiation of antibiotic; Chest X-ray improvement was defined as more than 30% improvement
We evaluated the clinical response to macrolides and doxycycline among children in macrolide-susceptible and macrolide-resistant cases

Summary

Introduction

Mycoplasma pneumoniae (MP) is an important cause for community-acquired pneumonia in children and adults [1,2]. MP infections in children are known as mild and self-limiting; antimicrobial treatment is recommended in children with moderate to severe lower respiratory tract infections [1,3,4]. MP is distinguished from other bacteria due to unique microbiologic characteristics, including lack of a cell wall, which attributes to being intrinsically resistant towards betalactams [5]. Antibiotics that act on the bacterial ribosome and inhibit protein synthesis such as macrolides or tetracyclines or agents that inhibit DNA replication such as fluoroquinolones are active against MP [6,7].

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