title: Treatment of resistant mycoplasma infection in immunocompromised patients with a new pleuromutilin antibiotic.
abstract: Patients with primary antibody deficiency (PAD) are prone to mycoplasma infection with unusual strains which may be resistant to conventional antibiotics. Mycoplasmas were isolated from the joint fluid (Ureaplasma urealyticum) of two PAD patients with arthritis and from the cerebral spinal fluid (Mycoplasma maculosum) in one with meningitis, the latter probably originating from the patient's dog. Combinations of doxycycline and quinolones or macrolides failed to clear the infections, but after demonstrating in-vitro sensitivity to the pleuromutilin, Econor, for two of the isolates, all three patients responded to oral treatment with Econor. The infection was completely eradicated in two patients, with the emergence of a resistant strain in the third. Mycoplasma infection should be considered in PAD patients with unexplained sepsis. Pleuromutilins such as Econor are powerful new anti-mycoplasmal agents which provide an additional therapeutic option when patients fail to respond to conventional antibiotics.
authors.affiliation: Pediatric Clinic II, Rigshospitalet, Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Heilmann
authors.forename: L
authors.initials: L
authors.lastname: Jensen
authors.forename: J S
authors.initials: JS
authors.lastname: Jensen
authors.forename: K
authors.initials: K
authors.lastname: Lundstrom
authors.forename: D
authors.initials: D
authors.lastname: Windsor
authors.forename: H
authors.initials: H
authors.lastname: Windsor
authors.forename: D
authors.initials: D
authors.lastname: Webster
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017074:Common Variable Immunodeficiency / Q000150:complications*; D004224:Diterpenes / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009174:Mycoplasma / Q000187:drug effects / Q000302:isolation & purification; D009175:Mycoplasma Infections / Q000188:drug therapy* / Q000276:immunology; D011083:Polycyclic Compounds; D016896:Treatment Outcome; D016869:Ureaplasma Infections / Q000188:drug therapy* / Q000276:immunology; D016990:Ureaplasma urealyticum / Q000187:drug effects / Q000302:isolation & purification; D000097567:Pleuromutilins
chemical_list: D000900:Anti-Bacterial Agents; D004224:Diterpenes; D011083:Polycyclic Compounds; D000097567:Pleuromutilins