title: Therapeutic efficacy of macrolides, minocycline, and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae pneumonia in pediatric patients.
abstract: The importance of macrolide-resistant (MR) Mycoplasma pneumoniae has become much more apparent in the past decade. We investigated differences in the therapeutic efficacies of macrolides, minocycline, and tosufloxacin against MR M. pneumoniae. A total of 188 children with M. pneumoniae pneumonia confirmed by culture and PCR were analyzed. Of these, 150 patients had a strain with an MR gene and 134 had one with an A-to-G mutation at position 2063 of M. pneumoniae 23S rRNA domain V. Azithromycin (n = 27), clarithromycin (n = 23), tosufloxacin (n = 62), or minocycline (n = 38) was used for definitive treatment of patients with MR M. pneumoniae. Defervescence within 48 h after the initiation of antibiotic therapy was observed in 41% of the patients in the azithromycin group, 48% of those in the clarithromycin group, 69% of those in the tosufloxacin group, and 87% of those in the minocycline group. The average number of days of fever after the administration of antibiotic treatment was lower in the minocycline and tosufloxacin groups than in the macrolide groups. The decrease in the M. pneumoniae burden, as estimated by the number of DNA copies, after 48 to 96 h of treatment was more rapid in patients receiving minocycline (P = 0.016) than in those receiving tosufloxacin (P = 0.049), azithromycin (P = 0.273), or clarithromycin (P = 0.107). We found that the clinical and bacteriological efficacies of macrolides against MR M. pneumoniae pneumonia was low. Our results indicated that minocycline rather than tosufloxacin can be considered the first-choice drug for the treatment of M. pneumoniae pneumonia in children aged ≥ 8 years.
authors: Department of Pediatrics, Kawasaki Medical School, Okayama, Japan.
authors: Yasuhiro
authors: Y
authors: Kawai
authors: Naoyuki
authors: N
authors: Miyashita
authors: Mika
authors: M
authors: Kubo
authors: Hiroto
authors: H
authors: Akaike
authors: Atsushi
authors: A
authors: Kato
authors: Yoko
authors: Y
authors: Nishizawa
authors: Aki
authors: A
authors: Saito
authors: Eisuke
authors: E
authors: Kondo
authors: Hideto
authors: H
authors: Teranishi
authors: Satoko
authors: S
authors: Ogita
authors: Takaaki
authors: T
authors: Tanaka
authors: Kozo
authors: K
authors: Kawasaki
authors: Takashi
authors: T
authors: Nakano
authors: Kihei
authors: K
authors: Terada
authors: Kazunobu
authors: K
authors: Ouchi
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008911:Minocycline / Q000627:therapeutic use*; D009154:Mutation; D009177:Mycoplasma pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000378:metabolism; D009287:Naphthyridines / Q000627:therapeutic use*; D011019:Pneumonia, Mycoplasma / Q000188:drug therapy* / Q000382:microbiology; D012329:RNA, Bacterial / Q000235:genetics; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D009287:Naphthyridines; D012329:RNA, Bacterial; D012338:RNA, Ribosomal, 23S; D017963:Azithromycin; D008911:Minocycline; C055185:tosufloxacin; D017291:Clarithromycin