Efficacy of levofloxacin on macrolide-unresponsive and corticosteroid-resistant refractory Mycoplasma pneumoniae pneumonia in children

Abstract

Background: This study aimed to summarize the experience in treatment of Mycoplasma pneumoniae pneumonia (MPP) with worsening lung shadow despite treatment with appropriate antimicrobials and corticosteroid in children.Methods: All patients satisfied refractory MP pneumonia (RMPP) diagnostic criteria were enrolled. The clinical manifestations, laboratory findings, imaging features, treatments, and outcomes were retrospectively reviewed.Results: Six patients with an average age of 7.83±3.13 years old were included in this study. All the patients were non-responsive to macrolide (ML) and glucocorticoids treatment shown by aggravated clinical symptoms and chest radiographies. The average total duration of fever was 19.5±8.34 days and the average time before levofloxacin (LVX) therapy was 10±2.97 days. After LVX treatment, the time of fever was from 1 to 3 days in five cases and 11 days in one case. The MP-DNA copies in the sputum decreased slowly after ML treatment in six patients, while they decreased quickly after LVX treatment in 5 children.A2063G mutation of domain V of 23SrRNA gene was found in five cases. Five patients recovered completely 16-32 days after treatment. One patient developed acute disseminated encephalomyelitis (ADEM) with abnormal brain magnetic resonance imaging and occurred serious sequelae. Conclusion:The sputum MP-DNA copies and clinical symptoms have a positive correlation with therapeutic efficacy. LVX may be beneficial in treatment of ML-unresponsive and corticosteroid-resistant RMPP in children. RMPP can be gradually cured by effective treatment of LVX, while which can damage the nervous system and lead to severe complications once MP invades brain tissues.

Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia

“…A previous study showed that a reduced MP-DNA copy number in the sputum was well correlated with patients' clinical symptoms and the therapeutic efficacy of antibiotics [34]. Studies have shown that levofloxacin and minocycline therapy in patients who are nonresponsive to macrolides may reduce their fever duration and result in a more rapid decrease in the sputum MP-DNA copy number [35,36]. Despite the efficacy of fluoroquinolones, clinicians should be aware of the adverse reactions (musculoskeletal adverse events), and the usage of fluoroquinolones should be based on in vitro activity and disease severity in children with MPP.…”

Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia

“…A previous study showed that a reduced MP-DNA copy number in the sputum was well correlated with patients' clinical symptoms and the therapeutic e cacy of antibiotics [33] . Studies have shown that levo oxacin and minocycline therapy in patients who are nonresponsive to macrolides may reduce their fever duration and result in a more rapid decrease in the sputum MP-DNA copy number [34,35] . Despite the e cacy of uoroquinolones, clinicians should be aware of the adverse reactions (musculoskeletal adverse events), and the usage of uoroquinolones should be based on in vitro activity and disease severity in children with MPP.…”

Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia

“…A previous study showed that a reduced MP-DNA copy number in the sputum was well correlated with patients' clinical symptoms and the therapeutic e cacy of antibiotics [34] . Studies have shown that levo oxacin and minocycline therapy in patients who are nonresponsive to macrolides may reduce their fever duration and result in a more rapid decrease in the sputum MP-DNA copy number [35,36] . Despite the e cacy of uoroquinolones, clinicians should be aware of the adverse reactions (musculoskeletal adverse events), and the usage of uoroquinolones should be based on in vitro activity and disease severity in children with MPP.…”