Therapeutic Efficacy and Safety of Prolonged Macrolide, Corticosteroid, Doxycycline, and Levofloxacin against Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children

Ha, Seok Gyun; Oh, Kyung Jin; Ko, Kwang-Pil; Sun, Yong Han; Ryoo, Eell; Tchah, Hann; Jeon, In Sang; Kim, Hyo Jeong; Ahn, Jung Min; Cho, Hye-Kyung

Macrolide resistance of MP is genetically determined by the 23S rRNA gene mutation. As there was no difference in the clinical manifestation between macrolide-susceptible M. pneumoniae (MSMP) and MRMP, it is difficult to clinically distinguish MRMP from MSMP. However, it has been reported that the duration of fever after the administration of macrolide was longer in MRMP than MSMP in childhood pneumonia and that persistent fever might suggest the possibility of infection with MRMP. The patients with MSMP achieved defervescence within 48-72 hours in more than 80% of cases after treatment with macrolide. 14,15,28 As mycoplasma takes a long time to isolate, antibiotic susceptibility testing is difficult to apply in practical clinical situations. Molecular tests to confirm macrolide resistance are not currently available in Korean hospitals, except in some cases for research purposes. Japanese societies have recommended a change of antibiotics to second-line agents when fever does not subside in 48-72 hours from macrolides administration. 28 In this study, macrolide-unresponsive MP pneumonia was defined as persistent fever of ≥ 38.0°C at ≥ 72 hours after macrolide treatment.