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. 2021 Feb 17;10(2):192.
doi: 10.3390/antibiotics10020192.

Clinical Efficacy of Doxycycline for Treatment of Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Children

Hyunju Lee  1   2 , Youn Young Choi  3 , Young Joo Sohn  3 , Ye Kyung Kim  3 , Mi Seon Han  4 , Ki Wook Yun  1   3 , Kyungmin Kim  2 , Ji Young Park  5 , Jae Hong Choi  6 , Eun Young Cho  7 , Eun Hwa Choi  1   3
Affiliations

Clinical Efficacy of Doxycycline for Treatment of Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Children

Hyunju Lee et al. Antibiotics (Basel). .

Abstract

In areas with high prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia, treatment in children has become challenging. This study aimed to analyze the efficacy of macrolides and doxycycline with regard to the presence of macrolide resistance. We analyzed children with MP pneumonia during the two recent epidemics of 2014-2015 and 2019-2020 from four hospitals in Korea. Nasopharyngeal samples were obtained from children with pneumonia for MP cultures and polymerase chain reaction (PCR). Macrolide resistance was determined by the analysis of 23S rRNA gene transition. Time to defervescence and to chest X-ray improvement were analyzed. Of 145 cases, the median age was 5.0 years and MRMP accounted for 59 (40.7%). Among macrolide-susceptible MP (MSMP), 78 (90.7%) were treated with macrolides and 21 (35.6%) in the MRMP group with doxycycline. In MRMP pneumonia, shorter days to defervescence (2 vs. 5 days, p < 0.001) and to chest X-ray improvement (3 vs. 6 days, p < 0.001) in the doxycycline group than in the macrolide group was observed, whereas no differences were observed among children with MSMP pneumonia. Compared to macrolides, treatment with doxycycline resulted in better outcomes with a shorter time to defervescence and to chest X-ray improvement among children with MRMP pneumonia.

Keywords: Mycoplasma pneumoniae; doxycycline; drug resistance; macrolides.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of cases included in the study for comparison of antibiotic response between macrolides and doxycycline in children with Mycoplasma pneumoniae pneumonia according to macrolide resistance. MP, Mycoplasma pneumoniae.
Figure 2
Figure 2
Cumulative incidence analysis of fever and chest X-ray improvement according to antibiotic group in children with macrolide-resistant Mycoplasma pneumoniae pneumonia. (a) Time to resolution of fever; (b) time to chest X-ray improvement in children treated with macrolides only or doxycycline (* including macrolides changed to doxycycline and doxycycline only).
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