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

In the DXC and LFX groups, no side effects such as tooth discoloration or tendinopathy and arthritis were observed. It was reported that tooth staining or color change were not observed in children aged between 2 and 8 years old treated with DXC. 37 However, because DXC, approved by the U.S. Food and Drug Administration for children aged ≥ 8 years old, is still contraindicated for children younger than 12 years of age in Korea, the age indications for tetracycline-bound drugs, including DXC, should be reconsidered. In addition, the risk of cartilage injury with LFX was clinically undetectable in children over 5 years old, or was easily reversible. 24 Of the 1,340 subjects treated with LFX, only one case (0.07%) was 'possibly related' to drug therapy assessed at 5 years, and this was not different from the comparator group (1/893, 0.1%). However, because concerns about the safety of tetracycline and fluoroquinolone in children still exist, it should be cautiously used with the consideration of both the risk and benefit in children with macrolide-unresponsive MP pneumonia. This study has some limitations. Firstly, as this study was performed retrospectively, the clinical information might be uncertain, especially with regard to the use and duration of macrolide prescribed in other clinics. Secondly, the numbers of patients in DXC and LFX groups were small. In the future, it is necessary to carry out prospective randomized studies or to conduct studies involving more subjects through multicenter studies. Lastly, the IgM antibody test was used to diagnose MP infection. Although the patients with a history of MP infection within past year were excluded, some subjects with false positive could be included due to prolonged existence of IgM for several months after past infection. In addition, false negatives could also exist due to a lack of IgM antibodies in early stages. However, other alternative methods, such as isolation or the molecular detection of MP, cannot differentiate asymptomatic carriage of MP in the nasopharynx from infection or MP pneumonia.