title: Rapid effectiveness of minocycline or doxycycline against macrolide-resistant Mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children.
abstract: BACKGROUND
  Mycoplasma pneumoniae is a major pathogen causing community-acquired pneumonia in children and young adults. Outbreaks typically occur at intervals of several years. In 2011, a widespread outbreak was associated with macrolide-resistant M. pneumoniae (MRMP) in Japanese children, often those of school age.
  
  
  METHODS
  Two hundred fifty-eight children were diagnosed with M. pneumoniae-associated pneumonia based on chest radiography, real-time polymerase chain reaction (PCR), and antibody titers between January and December 2011. Mycoplasma pneumoniae cultures obtained from nasopharyngeal samples using appropriate broth were subjected to real-time PCR, by which decreases in M. pneumoniae in patients treated with minocycline (MIN), doxycycline (DOX), or tosufloxacin (TFX) were calculated. Mutations of the 23S ribosomal RNA gene that confer high resistance to macrolides in M. pneumoniae were identified by DNA sequencing.
  
  
  RESULTS
  Among 202 M. pneumoniae isolates from M. pneumoniae-associated pneumonia patients, 176 (87.1%) were MRMP. Macrolide-resistant M. pneumoniae infection was significantly related to school age (P < .01) and initial administration of macrolides (P < .01). Minocycline or DOX (n = 125) or TFX or levofloxacin (n = 15) was used for definitive treatment of MRMP patients. Minocycline or DOX was significantly more effective than TFX (P ≤ .05) in achieving defervescence within 24 hours and in decreasing numbers of M. pneumoniae DNA copies 3 days after initiation.
  
  
  CONCLUSIONS
  Macrolides are inappropriate as first-choice agents against MRMP in terms of shortening the clinical course and decreasing M. pneumoniae. Control and prevention of MRMP outbreaks in children require early decreases in M. pneumoniae as well as improvement of clinical findings.
authors.affiliation: Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Okada
authors.forename: Miyuki
authors.initials: M
authors.lastname: Morozumi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tajima
authors.forename: Maki
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakata
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ohnari
authors.forename: Naoko
authors.initials: N
authors.lastname: Chiba
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iwata
authors.forename: Kimiko
authors.initials: K
authors.lastname: Ubukata
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004318:Doxycycline / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008911:Minocycline / Q000627:therapeutic use*; D009177:Mycoplasma pneumoniae / Q000302:isolation & purification*; D011019:Pneumonia, Mycoplasma / Q000188:drug therapy* / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008911:Minocycline; D004318:Doxycycline