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

Mycoplasma pneumoniae (MP) is one of the most common pathogens of community-acquired pneumonia in children and adolescents. It can cause a variety of clinical manifestations, from mild respiratory symptoms to severe fatal pneumonia with extrapulmonary Given the increase of MRMP, some secondary treatment agents, such as corticosteroids, tetracyclines, and fluoroquinolones, have been considered for the treatment of MRMP pneumonia, although several studies have suggested that macrolides have clinical efficacy for the treatment of MRMP. [17] [18] [19] Tetracyclines, including minocycline and doxycycline, have been reported as alternative agents for children with MRMP. 20,21 However, they are not recommended for use in patients younger than 8 years of age, because tetracyclines can cause tooth discoloration in children during the periods of osteogenesis and odontogenesis. 22 In addition, fluoroquinolones have been associated with a risk of musculoskeletal toxicities, including tendinitis, arthritis, and growth impairment in children. 23 Although there is still lack of information on their safety in children, it was reported that there were no clinically detectable adverse events for up to 5 years after treatment with levofloxacin (LFX). 24 Some studies have reported the clinical effectiveness of systemic corticosteroids (CST) in the treatment of refractory MP pneumonia, because hyper-reaction of the host immune system may contribute to its pathogenesis. 25, 26 However, CST can also cause several side effects, such as growth disorder, glucose intolerance, and the suppression of the immune system. 27 We aimed to compare the therapeutic efficacy of prolonged macrolides (PMCs), CST, doxycycline (DXC), and LFX against macrolide-unresponsive MP pneumonia in children, and to evaluate the safety of CST, DXC, and LFX.