Therapeutic efficacy of azithromycin, clarithromycin, minocycline and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients

• Published in: PloS one Vol. 12; no. 3; p. e0173635
• Main Authors: Ishiguro, Nobuhisa, Koseki, Naoko, Kaiho, Miki, Ariga, Tadashi, Kikuta, Hideaki, Togashi, Takehiro, Oba, Koji, Morita, Keisuke, Nagano, Naoko, Nakanishi, Masanori, Hara, Kazuya, Hazama, Kyosuke, Watanabe, Toru, Yamanaka, Tatsuru, Sasaki, Satoshi, Furuyama, Hideto, Shibata, Mutsuo, Shida, Satoru, Ishizaka, Akihito, Tabata, Yuichi, Aoyagi, Hayato, Naito, Hiroyuki, Yoshioka, Mikio, Horino, Atsuko, Kenri, Tsuyoshi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.03.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Analysis; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Azithromycin; Azithromycin - therapeutic use; Bacteriology; Biology and Life Sciences; Chemotherapy; Child; Children; Clarithromycin; Clarithromycin - therapeutic use; Dosage and administration; Drug Resistance, Bacterial - drug effects; Drug therapy; Female; Fever; Fluoroquinolones - therapeutic use; Health aspects; Hospitals; Humans; Infections; Infectious diseases; Informed consent; Male; Medicine; Medicine and Health Sciences; Microbial Sensitivity Tests; Minocycline; Minocycline - therapeutic use; Mycoplasma pneumonia; Mycoplasma pneumoniae; Mycoplasma pneumoniae - drug effects; Mycoplasma pneumoniae - genetics; Naphthyridines - therapeutic use; Observational studies; Patients; Pediatrics; Physical Sciences; Pneumonia; Pneumonia, Mycoplasma - drug therapy; Pneumonia, Mycoplasma - etiology; Tosufloxacin; Treatment Outcome; University graduates
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0173635

To clarify therapeutic effects of azithromycin, clarithromycin, minocycline and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia and against macrolide-sensitive Mycoplasma pneumoniae (MSMP) pneumonia in pediatric patients. A prospective, multicenter observational study was conducted from July 2013 to August 2015. The therapeutic effects of azithromycin, clarithromycin, minocycline and tosufloxacin were evaluated in 59 patients with pneumonia caused by MRMP and in 50 patients with pneumonia caused by MSMP. In vitro activities of antimicrobial agents against isolates of Mycoplasma pneumoniae were also measured. Mean durations of fever following commencement of treatment in patients infected with MRMP and MSMP were 5.2 and 1.9 days, respectively (log-rank test, P < 0.0001). Among patients infected with MRMP, mean durations of fever were 4.6, 5.5, 1.0 and 7.5 days for patients treated with azithromycin, clarithromycin, minocycline and tosufloxacin, respectively (log-rank test, P < 0.0001). Among patients infected with MSMP, mean durations of fever were 2.5, 1.7, 0.9 and 4.3 days for patients treated with azithromycin, clarithromycin, minocycline and tosufloxacin, respectively (log-rank test, P = 0.0162). The MIC90s of azithromycin and clarithromycin among the 27 isolates of MRMP were 64 and 256 μg/ml, respectively, and those among the 23 isolates of MSMP were <0.000125 and 0.001 μg/ml, respectively. The MIC90s of minocycline and tosufloxacin among the 27 isolates of MRMP were 1.0 and 0.25 μg/ml, respectively, and those among the 23 isolates of MSMP were 1.0 and 0.5 μg/ml, respectively. Both minocycline and tosufloxacin showed good in vitro activities against MRMP. Minocycline, but not tosufloxacin, shortened the duration of fever in pediatric patients infected with MRMP compared to the duration of fever in patients treated with macrolides.