Therapeutic Efficacy of Macrolides, Minocycline, and Tosufloxacin against Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Pediatric Patients
Therapeutic Efficacy of Macrolides, Minocycline, and Tosufloxacin against Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Pediatric Patients
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DOI：
10.1128/aac.00048-13
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发表时间：
2013-05-01
影响因子：
4.9
通讯作者：
Ouchi, Kazunobu
中科院分区：
文献类型：
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作者：
Kawai, Yasuhiro;Miyashita, Naoyuki;Ouchi, Kazunobu
在过去的十年中，大环内酯类耐药 (MR) 肺炎支原体的重要性变得更加明显。我们研究了大环内酯类、米诺环素和托舒沙星对肺炎支原体的治疗效果的差异。共分析了 188 例经培养和 PCR 确诊的肺炎支原体肺炎儿童。其中，150 名患者的菌株带有 MR 基因，134 名患者的菌株在肺炎支原体 23S rRNA 结构域 V 的 2063 位处具有 A 至 G 突变。阿奇霉素 (n = 27)、克拉霉素 (n = 23)、托舒沙星 (n = 62) 或米诺环素 (n = 38) 用于 MR M 患者的明确治疗。肺炎杆菌。阿奇霉素组、克拉霉素组、托舒沙星组、米诺环素组分别有 41%、48%、69%、87% 的患者在开始抗生素治疗后 48 小时内出现退热。米诺环素和妥舒沙星组给予抗生素治疗后平均发烧天数低于大环内酯组。根据 DNA 拷贝数估计，治疗 48 至 96 小时后，接受米诺环素 (P = 0.016) 的患者肺炎支原体负荷的下降速度比接受托舒沙星 (P = 0.049)、阿奇霉素 (P = 0.273) 或克拉霉素 (P = 0.107) 的患者更快。我们发现大环内酯类药物对 MR 肺炎支原体肺炎的临床和细菌学疗效较低。我们的研究结果表明，米诺环素而非托舒沙星可作为治疗 8 岁以上儿童肺炎支原体肺炎的首选药物。
The importance of macrolide-resistant (MR) Mycoplasma pneumoniae has become much more apparent in the past decade. We investigated differences in the therapeutic efficacies of macrolides, minocycline, and tosufloxacin against MR M. pneumoniae. A total of 188 children with M. pneumoniae pneumonia confirmed by culture and PCR were analyzed. Of these, 150 patients had a strain with an MR gene and 134 had one with an A-to-G mutation at position 2063 of M. pneumoniae 23S rRNA domain V. Azithromycin (n = 27), clarithromycin (n = 23), tosufloxacin (n = 62), or minocycline (n = 38) was used for definitive treatment of patients with MR M. pneumoniae. Defervescence within 48 h after the initiation of antibiotic therapy was observed in 41% of the patients in the azithromycin group, 48% of those in the clarithromycin group, 69% of those in the tosufloxacin group, and 87% of those in the minocycline group. The average number of days of fever after the administration of antibiotic treatment was lower in the minocycline and tosufloxacin groups than in the macrolide groups. The decrease in the M. pneumoniae burden, as estimated by the number of DNA copies, after 48 to 96 h of treatment was more rapid in patients receiving minocycline (P = 0.016) than in those receiving tosufloxacin (P = 0.049), azithromycin (P = 0.273), or clarithromycin (P = 0.107). We found that the clinical and bacteriological efficacies of macrolides against MR M. pneumoniae pneumonia was low. Our results indicated that minocycline rather than tosufloxacin can be considered the first-choice drug for the treatment of M. pneumoniae pneumonia in children aged >= 8 years.