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

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.

Macrolide-Resistant and Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia in Children Treated Using Early Corticosteroids

“…The prevalence of macrolide-resistant M. pneumoniae was reportedly 87% in Japan during 2011 [21], although other Japanese groups had reported that the prevalence of macrolide-resistant M. pneumoniae has decreased recently in Japan [22]. In contrast, Korea and China have reported high proportions of macrolide-resistant M. pneumoniae infections until recently [12,23]. A lower prevalence has been reported in the US (mean: 7.5%, range: 1.9-21.7%) [14], and an even lower prevalence has been observed in some European countries [24,25].…”

“…Previous studies have demonstrated that macrolide-resistant M. pneumoniae can prolong the durations of fever and hospital stay and is associated with a higher frequency of alternative antibiotic treatment after macrolide treatment, relative to macrolide-resistant M. pneumoniae [7,8,12,19,26]. Meanwhile, some studies have failed to detect significant differences in clinical presentation, radiographic findings, complications, or admission duration [13,14,20].…”

“…Some groups have reported that patients with macrolide-resistant M. pneumoniae pneumonia have more severe clinical manifestations, such as longer fever duration and hospitalization, relative to patients with macrolide-sensitive M. pneumoniae pneumonia [7,10,12]. However, other groups have reported that macrolide-resistant M. pneumoniae pneumonia might respond to macrolide treatment and that some clinical indices did not differ between macrolide-resistant and macrolide-sensitive M. pneumoniae pneumonia [13,14].…”

Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management

“…Clinical attempts on tetracyclines are uplifting and promising. Minocycline and doxycycline (recommended as twice-daily dose of 4 mg/kg/day [ 115 , 116 ]) were mostly reported with rapid effectiveness and a relatively low incidence of adverse reactions [ 94 , 113 , 116 , 117 , 118 , 119 ]. Doxycycline has also been recommended as the first alternate antibiotic for macrolide-resistant MPP [ 113 ].…”

Macrolide versus Non-Macrolide in Combination with Steroids for the Treatment of Lobar or Segmental Mycoplasma pneumoniae Pneumonia Unresponsive to Initial Macrolide Monotherapy

“…In the last few decades, macrolide-resistant (MR) MP has been increasing in proportion, leading to children becoming unresponsive to the initial macrolide therapy [ 5 ]. Therefore, even considering the potential toxicities of tetracyclines and fluoroquinolones in children, their uses have been increasing in those suspected of MRMP or in patients with clinical deterioration [ 6 , 7 ]. Because immunologic mechanisms are known to play an important role in MP, steroids have also been used effectively and safely in children with severe pneumonia [ 8 , 9 ].…”