Overview of antimicrobial options for Mycoplasma pneumoniae pneumonia: focus on macrolide resistance

Abstract

The problem of macrolide resistant M. pneumonia is emerging. Antibiotic stewardship is needed to inhibit the inappropriate use of macrolide and new antibiotics with a more acceptable safety profile for all ages need to be explored.

Macrolide-resistant Mycoplasma pneumoniae prevalence and clinical aspects in adult patients with community-acquired pneumonia in China: a prospective multicenter surveillance study

“…In the present study, we found that 80% of MP isolated strains were resistant to ERY, and 72% were resistant to AZM. Fifty-five ERYresistant MP strains harbored an A2063G transition in the 23S rRNA genes and one harbored an A2064G transition, which was consistent with previous reports that the A2063G transition was the most frequent mutation related to macrolides resistance (2,10). Further, it is interesting to note that 6 strains with mild to moderate ERY-resistance level were still susceptible to AZM, among which only 2 strains (MIC value 16 and 32 μg/mL, respectively) harbored an A2063G transition.…”

“…Mutations in the sequence of 23S rRNA, A2063G was the most prevalent, followed by A2064G, A2063T and A1290G. A2063G and A2064G mutations are always responsible for the high-level macrolide resistance in MP (2). In the present study, we found that 80% of MP isolated strains were resistant to ERY, and 72% were resistant to AZM.…”

“…Mycoplasma pneumoniae (MP) is a major cause of CAP worldwide and accounts for up to 40% of the cases in China (1). International guidelines have recommended macrolides or tetracyclines (TET) as the first-line drugs and fluoroquinolones as the second-line drugs in adults, whereas azithromycin (AZM) as the first-line drug, and clarithromycin, erythromycin (ERY), or doxycycline (for patients aged >8 years) along with fluoroquinolones [levofloxacin (LVX) or MOX for adolescent patients] as the second-line oral drugs, for mild pediatric cases (2). However, the emergence of macrolide-resistant MP (MRMP) has gradually increased worldwide in the last decade, especially in China and Japan the resistance rate has reached up to 90% (2)(3)(4)(5).…”

“…International guidelines have recommended macrolides or tetracyclines (TET) as the first-line drugs and fluoroquinolones as the second-line drugs in adults, whereas azithromycin (AZM) as the first-line drug, and clarithromycin, erythromycin (ERY), or doxycycline (for patients aged >8 years) along with fluoroquinolones [levofloxacin (LVX) or MOX for adolescent patients] as the second-line oral drugs, for mild pediatric cases (2). However, the emergence of macrolide-resistant MP (MRMP) has gradually increased worldwide in the last decade, especially in China and Japan the resistance rate has reached up to 90% (2)(3)(4)(5). Macrolides are preferred over other antimicrobials due to the lack of cell wall in MP; however, macrolides are susceptible to resistance due to point mutations in few positions of domain V of the peptidyl transferase loop of 23S ribosomal RNA (rRNA) gene (such as A2063G, A2064G, A2063C, A2063T, A2067G, and C2617G) and at the location of macrolide binding to the 50S bacterial ribosome subunit reduces the affinity of the antibiotic towards the ribosome (1,2,6).…”

“…However, the emergence of macrolide-resistant MP (MRMP) has gradually increased worldwide in the last decade, especially in China and Japan the resistance rate has reached up to 90% (2)(3)(4)(5). Macrolides are preferred over other antimicrobials due to the lack of cell wall in MP; however, macrolides are susceptible to resistance due to point mutations in few positions of domain V of the peptidyl transferase loop of 23S ribosomal RNA (rRNA) gene (such as A2063G, A2064G, A2063C, A2063T, A2067G, and C2617G) and at the location of macrolide binding to the 50S bacterial ribosome subunit reduces the affinity of the antibiotic towards the ribosome (1,2,6). Eventually fluoroquinolone therapy has emerged as an efficient treatment option for MP CAP (7).…”