Macrolides are the first-choice agents for treating Mycoplasma pneumoniae infection. Tetracyclines and fluoroquinolones are not recommended in children due to adverse effects. Recently, prevalence of macrolide-resistant M. pneumoniae infections has rapidly increased among Japanese children; thus, tetracyclines or quinolones are increasingly being used. However, there are no prospective data showing preference for tetracycline or quinolone treatment in macrolides nonresponders.
We enrolled children ≥ 8 y of age diagnosed with clinically macrolide-resistant M. pneumoniae pneumonia; the diagnosis was based on fever and respiratory symptoms, abnormal chest x-ray findings, and detection of loop-mediated isothermal amplification assay-amplified M. pneumoniae DNA in a throat swab. “Clinically macrolide-resistant” was defined as persistent fever (axillary temperature ≥ 37.5ºC) at 48–72 h after using macrolides. Patients were randomized to receive either oral minocycline (MINO) 4 mg/kg/day q12h or oral tosufloxacin (TFLX) 12 mg/kg/day q12h; those with both persistent fever and invariant respiratory symptoms after at least 72 h of treatment were defined as “treatment failure,” and were switched to either TFLX or MINO. Time for the temperature to come down to <37.5ºC for 24 h continuously and for resolution of cough were major outcomes. Rates of treatment failure and adverse events were secondary outcomes.
Of the 77 enrolled children, 38 and 39 children were randomized to use MINO and TFLX, respectively. There were no differences in patient characteristics (age, sex, duration of macrolide use, and day of illness at randomization). Time taken for the temperature to come down (1.4 ± 1.7 vs. 2.4 ± 1.5 days) and for resolution of cough (2.1 ± 1.2 vs. 3.4 ± 1.6 days) were significantly shorter in children using MINO than in those using TFLX, respectively, (p < 0.05). Treatment failure was observed in 6 children from the TFLX group (15.8%) and none from the MINO group. No severe adverse events were observed, and rates of mild events, such as rash and nausea, were similar in both groups.
MINO is more effective than TFLX in the treatment of clinically macrolide-resistant M. pneumoniae pneumonia in children ≥ 8 y of age.
S. Kito, None
K. Haruta, None
K. Kozawa, None
H. Hibino, None
M. Kawaguchi, None
T. Noguchi, None
N. Fujishiro, None
K. Takemoto, None
T. Ozaki, None
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