Therapeutic Efficacy of Macrolides, Minocycline, and Tosufloxacin against Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Pediatric Patients

Kawai, Yasuhiro; Miyashita, Naoyuki; Kubo, Mika; Akaike, Hiroto; Kato, Atsushi; Saito, Aki; Kondo, Eisuke; Teranishi, Hideto; Ogita, Satoko; Tanaka, Takaaki; Kawasaki, Kozo; Nakano, Takashi; Terada, Kihei; Ouchi, Kazunobu

doi:10.1128/aac.00048-13

Cited by 90 publications

(96 citation statements)

References 22 publications

(37 reference statements)

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“…Recent studies have demonstrated that tetracyclines and fluoroquinolones are effective treatments for patients with macrolide-resistant M. pneumoniae infections (26). In particular, administration of minocycline was shown to decrease the number of DNA copies found in the nasopharynxes of children with macrolide-resistant M. pneumoniae infections (27).…”

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confidence: 99%

Cluster of Macrolide-Resistant Mycoplasma pneumoniae Infections in Illinois in 2012

Tsai

Pritzker²,

Diaz

et al. 2013

J Clin Microbiol

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c Macrolide-resistant Mycoplasma pneumoniae is an increasing problem worldwide but is not well documented in the United States. We report a cluster of macrolide-resistant M. pneumoniae cases among a mother and two daughters. CASE REPORTSP atient 1. Patient 1 was an 8-year-old female with antecedent history of asthma who developed fatigue and fever of up to 104.3°F on 18 November 2012. On day 2, she consulted with her primary care physician (PCP); her chest examination was normal, and a nasopharyngeal (NP) specimen collected for influenza was negative. Her PCP recommended symptomatic treatment of the fever and a follow-up visit if there was no improvement in 3 to 4 days; no antibiotics were prescribed at this visit. By day 3 she started having additional symptoms such as cough, headache, nausea, and chest pain. She was reevaluated by her PCP on day 4; chest radiography showed an infiltrate in the right upper lobe with mild volume loss, and a 5-day course of azithromycin was subsequently prescribed. By day 6, fever persisted despite 3 days of azithromycin treatment; a repeat chest radiograph showed slight improvement in the infiltrate. Azithromycin treatment was continued, and albuterol was administered via nebulizer three times daily. Despite completion of the course of azithromycin, fever persisted, prompting the administration of cefdinir on day 8 and of corticosteroids (oral and inhaled) because of wheezing on day 9. The 10-day course of cefdinir was completed; she remained afebrile and gradually improved after 2 weeks. The total illness course was 24 days.Patient 2. Patient 2 was a healthy 38-year-old female (mother of patient 1) with no history of smoking or asthma. She developed fever of up to 103°F on 15 December 2012, approximately 1 month after onset of fever in patient 1. On day 2, she presented to her PCP with cough, dizziness, aches, and upper respiratory symptoms. An NP specimen collected at this visit for rapid influenza testing was negative. Given the marginal sensitivity of the rapid influenza test and widespread influenza A H3N2 virus activity in the country at the time, her PCP elected to treat an influenzalike illness with oseltamivir. The fever persisted, and azithromycin was added to the treatment regimen on day 3. She was reevaluated by her PCP on day 5, and a chest radiograph showed left lower lobe pneumonia. Based on the radiographic findings, azithromycin was stopped and levofloxacin was administered on day 5. Because of wheezing, inhaled albuterol was administered. Although the fever resolved by day 7, cough and wheezing persisted, which prompted the administration of a course of oral corticosteroids by her PCP on day 10. Cough and wheezing gradually improved over the following week, resulting in a total illness course of 17 days.Patient 3. Patient 3 was an otherwise healthy 10-year-old female (sister of patient 1 and daughter of patient 2) with no history of asthma. She presented with fever of up to 104.5°F, dizziness, and headache on 27 December 2012, approximately 2 weeks after the on...

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Cluster of Macrolide-Resistant Mycoplasma pneumoniae Infections in Illinois in 2012

Tsai

Pritzker²,

Diaz

et al. 2013

J Clin Microbiol

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“…The antimicrobial agents used for MIC determination were as follows: erythromycin, clarithromycin, azithromycin, rokitamycin, clindamycin, minocycline, tetracycline, tosufloxacin, garenoxacin, levofloxacin, and moxifloxacin. The MICs against M. pneumoniae isolates collected in this study were compared with those against MR isolates from pediatric patients that were collected in another study (9).…”

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confidence: 99%

“…A search for mutations at positions 2063, 2064, and 2617 in the M. pneumoniae 23S rRNA domain V gene region was performed using a direct sequencing method in samples with a positive culture or PCR result, as reported previously (7)(8)(9). The MICs of 11 antimicrobial agents for the M. pneumoniae isolates were determined by microdilution methods (18).…”

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Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Adolescents and Adults: Clinical Findings, Drug Susceptibility, and Therapeutic Efficacy

Miyashita

Akaike

Teranishi

et al. 2013

Antimicrob Agents Chemother

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We investigated differences in the clinical findings between 30 patients with macrolide-resistant Mycoplasma pneumoniae pneumonia and 43 patients with macrolide-sensitive M. pneumoniae pneumonia in adolescents and adults. No differences in clinical presentation were observed between the two groups. Among patients with macrolide-resistant Mycoplasma pneumoniae pneumonia, treatment was more effective in the groups that received quinolones and minocycline than in the group that received macrolides (P ‫؍‬ 0.0361 and P ‫؍‬ 0.0237, respectively). Mycoplasma pneumoniae is a major cause of community-acquired pneumonia (CAP) in school-age children and young adults (1, 2). A specific diagnosis of M. pneumoniae infection is important because treatment with routinely used ␤-lactam antibiotics is ineffective against these organisms because they lack a cell wall. Thus, the Japanese Respiratory Society (JRS) CAP guidelines have been recommended as a rapid and simple scoring system based on clinical and laboratory findings for the presumptive diagnosis of M. pneumoniae pneumonia (1,3,4). Our recent study demonstrated that the JRS scoring system was the most useful tool for initiating the administration of adequate antibiotic therapy for probable M. pneumoniae pneumonia among the rapid diagnostic methods tested (5).Although M. pneumoniae pneumonia is usually mild in severity, macrolide-resistant (MR) M. pneumoniae with mutations in the 23S rRNA gene has emerged in pediatric patients with CAP (6, 7). More than 60% of M. pneumoniae strains in pediatric patients showed high resistance to 14-and 15-membered ring macrolides with a MIC of Ն64 mg/liter (8-10). The clinical and bacteriological efficacy of macrolides for treating cases of MR M. pneumoniae pneumonia was lower than that in cases of macrolide-sensitive (MS) M. pneumoniae pneumonia in pediatric patients (9-13). In contrast to pediatric patients, the available data on MR M. pneumoniae infection in adolescent and adult patients are limited (8,14). The purpose of the present study was to identify a means of rapidly distinguishing MR M. pneumoniae pneumonia from MS M. pneumoniae pneumonia in daily clinical practice without waiting for genetic analysis results. We compared the underlying conditions, pneumonia severity, clinical symptoms, laboratory data, prognostic factors, and radiographic findings between patients with MR M. pneumoniae pneumonia and those with MS M. pneumoniae pneumonia (MR patients and MS patients, respectively) in adolescents and adults. Based on the clinical presentation, we evaluated the usefulness of rapid and simple clinical diagnostic methods (5), the JRS scoring system (1, 3, 4), and high-resolution computed tomography (HRCT) (15, 16) for the early presumptive diagnosis of M. pneumoniae pneumonia. An additional purpose of this study was to investigate the drug susceptibility of MR isolates and differences in therapeutic efficacy against MR M. pneumoniae among macrolides, quinolones, and minocycline.Adolescent and adult patients with CAP who visited 12 i...

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“…Macrolides are used as the first‐line therapy for the treatment of M. pneumoniae infections, especially in children, owing to their high efficacy8 and safety profile 9, 10. However, macrolide resistance of M. pneumoniae, which is acquired by mutations of the ribosomal target of macrolides,11 has been spreading rapidly and widely since 2000,12 resulting in enhanced disease severity with increased complications 13, 14…”

Section: Introductionmentioning

confidence: 99%

Clinical features and seasonal variations in the prevalence of macrolide‐resistant Mycoplasma pneumoniae

Akashi

Hayashi

Suzuki

et al. 2018

J of Gen and Family Med

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Background Mycoplasma pneumoniae is a common pathogen causing pneumonia; macrolide‐resistant strains are rapidly spreading across Japan. However, the clinical features of macrolide‐resistant M. pneumoniae pneumonia have not been well established. Here, we evaluated the clinical characteristics and seasonal variations in the prevalence of M. pneumoniae with macrolide‐resistant mutations (MRM).MethodsThe monthly prevalence of MRM in M. pneumoniae strains isolated from May 2016 to April 2017 was retrospectively analyzed, and the clinical characteristics of pneumonia cases with MRM were compared to those of cases without MRM. The M. pneumoniae isolates and point mutations at site 2063 or 2064 in domain V of 23S rRNA were evaluated by the GENECUBE system and GENECUBE Mycoplasma detection kit.Results Mycoplasma pneumoniae infection was identified in 383 cases, including 221 cases of MRM (57.7%). The MRM prevalence was 86.3% (44/51) between May and July 2016, demonstrating an apparent decrease in September 2016, subsequently reaching 43.0% (34/79) in November 2016. Mycoplasma pneumoniae pneumonia was diagnosed in 275 cases, including 222 pediatric and 53 adult cases. Macrolide use preceding evaluation was found to be the only feature of MRM pneumonia cases both in children (odds ratio [OR] 3.86, 95% confidence interval [CI]:1.72–8.66) and in adults (OR 7.43, 95% CI: 1.67–33.1).ConclusionsThe determination rate of MRM varied widely throughout the year, and our study demonstrated the challenges in predicting M. pneumoniae with MRM based on clinical features at diagnosis. Therefore, continuous monitoring of the prevalence of MRM is warranted, which may help in selecting an effective treatment.

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Therapeutic Efficacy of Macrolides, Minocycline, and Tosufloxacin against Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Pediatric Patients

Cited by 90 publications

References 22 publications

Cluster of Macrolide-Resistant Mycoplasma pneumoniae Infections in Illinois in 2012

Cluster of Macrolide-Resistant Mycoplasma pneumoniae Infections in Illinois in 2012

Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Adolescents and Adults: Clinical Findings, Drug Susceptibility, and Therapeutic Efficacy

Clinical features and seasonal variations in the prevalence of macrolide‐resistant Mycoplasma pneumoniae

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