Rapid effectiveness of minocycline or doxycycline against macrolide-resistant mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children

Takafumi Okada, Miyuki Morozumi, Takeshi Tajima, Maki Hasegawa, Hiroshi Sakata, Shigeru Ohnari, Naoko Chiba, Satoshi Iwata, Kimiko Ubukata

Research output: Contribution to journalArticle

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Abstract

Background. Mycoplasma pneumoniae is a major pathogen causing community-acquired pneumonia in children and young adults. Outbreaks typically occur at intervals of several years. In 2011, a widespread outbreak was associated with macrolide-resistant M. pneumoniae (MRMP) in Japanese children, often those of school age.Methods. Two hundred fifty-eight children were diagnosed with M. pneumoniae-associated pneumonia based on chest radiography, real-time polymerase chain reaction (PCR), and antibody titers between January and December 2011. Mycoplasma pneumoniae cultures obtained from nasopharyngeal samples using appropriate broth were subjected to real-time PCR, by which decreases in M. pneumoniae in patients treated with minocycline (MIN), doxycycline (DOX), or tosufloxacin (TFX) were calculated. Mutations of the 23S ribosomal RNA gene that confer high resistance to macrolides in M. pneumoniae were identified by DNA sequencing.Results. Among 202 M. pneumoniae isolates from M. pneumoniae-associated pneumonia patients, 176 (87.1%) were MRMP. Macrolide-resistant M. pneumoniae infection was significantly related to school age (P <. 01) and initial administration of macrolides (P <. 01). Minocycline or DOX (n = 125) or TFX or levofloxacin (n = 15) was used for definitive treatment of MRMP patients. Minocycline or DOX was significantly more effective than TFX (P ≤. 05) in achieving defervescence within 24 hours and in decreasing numbers of M. pneumoniae DNA copies 3 days after initiation.Conclusions. Macrolides are inappropriate as first-choice agents against MRMP in terms of shortening the clinical course and decreasing M. pneumoniae. Control and prevention of MRMP outbreaks in children require early decreases in M. pneumoniae as well as improvement of clinical findings.

Original languageEnglish
Pages (from-to)1642-1649
Number of pages8
JournalClinical Infectious Diseases
Volume55
Issue number12
DOIs
Publication statusPublished - 2012 Dec 15
Externally publishedYes

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Mycoplasma pneumoniae
Minocycline
Doxycycline
Macrolides
Disease Outbreaks
Infection
tosufloxacin
Pneumonia
Real-Time Polymerase Chain Reaction
23S Ribosomal RNA
Levofloxacin

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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Rapid effectiveness of minocycline or doxycycline against macrolide-resistant mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children. / Okada, Takafumi; Morozumi, Miyuki; Tajima, Takeshi; Hasegawa, Maki; Sakata, Hiroshi; Ohnari, Shigeru; Chiba, Naoko; Iwata, Satoshi; Ubukata, Kimiko.

In: Clinical Infectious Diseases, Vol. 55, No. 12, 15.12.2012, p. 1642-1649.

Research output: Contribution to journalArticle

Okada, T, Morozumi, M, Tajima, T, Hasegawa, M, Sakata, H, Ohnari, S, Chiba, N, Iwata, S & Ubukata, K 2012, 'Rapid effectiveness of minocycline or doxycycline against macrolide-resistant mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children', Clinical Infectious Diseases, vol. 55, no. 12, pp. 1642-1649. https://doi.org/10.1093/cid/cis784
Okada, Takafumi ; Morozumi, Miyuki ; Tajima, Takeshi ; Hasegawa, Maki ; Sakata, Hiroshi ; Ohnari, Shigeru ; Chiba, Naoko ; Iwata, Satoshi ; Ubukata, Kimiko. / Rapid effectiveness of minocycline or doxycycline against macrolide-resistant mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children. In: Clinical Infectious Diseases. 2012 ; Vol. 55, No. 12. pp. 1642-1649.
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AU - Okada, Takafumi

AU - Morozumi, Miyuki

AU - Tajima, Takeshi

AU - Hasegawa, Maki

AU - Sakata, Hiroshi

AU - Ohnari, Shigeru

AU - Chiba, Naoko

AU - Iwata, Satoshi

AU - Ubukata, Kimiko

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N2 - Background. Mycoplasma pneumoniae is a major pathogen causing community-acquired pneumonia in children and young adults. Outbreaks typically occur at intervals of several years. In 2011, a widespread outbreak was associated with macrolide-resistant M. pneumoniae (MRMP) in Japanese children, often those of school age.Methods. Two hundred fifty-eight children were diagnosed with M. pneumoniae-associated pneumonia based on chest radiography, real-time polymerase chain reaction (PCR), and antibody titers between January and December 2011. Mycoplasma pneumoniae cultures obtained from nasopharyngeal samples using appropriate broth were subjected to real-time PCR, by which decreases in M. pneumoniae in patients treated with minocycline (MIN), doxycycline (DOX), or tosufloxacin (TFX) were calculated. Mutations of the 23S ribosomal RNA gene that confer high resistance to macrolides in M. pneumoniae were identified by DNA sequencing.Results. Among 202 M. pneumoniae isolates from M. pneumoniae-associated pneumonia patients, 176 (87.1%) were MRMP. Macrolide-resistant M. pneumoniae infection was significantly related to school age (P <. 01) and initial administration of macrolides (P <. 01). Minocycline or DOX (n = 125) or TFX or levofloxacin (n = 15) was used for definitive treatment of MRMP patients. Minocycline or DOX was significantly more effective than TFX (P ≤. 05) in achieving defervescence within 24 hours and in decreasing numbers of M. pneumoniae DNA copies 3 days after initiation.Conclusions. Macrolides are inappropriate as first-choice agents against MRMP in terms of shortening the clinical course and decreasing M. pneumoniae. Control and prevention of MRMP outbreaks in children require early decreases in M. pneumoniae as well as improvement of clinical findings.

AB - Background. Mycoplasma pneumoniae is a major pathogen causing community-acquired pneumonia in children and young adults. Outbreaks typically occur at intervals of several years. In 2011, a widespread outbreak was associated with macrolide-resistant M. pneumoniae (MRMP) in Japanese children, often those of school age.Methods. Two hundred fifty-eight children were diagnosed with M. pneumoniae-associated pneumonia based on chest radiography, real-time polymerase chain reaction (PCR), and antibody titers between January and December 2011. Mycoplasma pneumoniae cultures obtained from nasopharyngeal samples using appropriate broth were subjected to real-time PCR, by which decreases in M. pneumoniae in patients treated with minocycline (MIN), doxycycline (DOX), or tosufloxacin (TFX) were calculated. Mutations of the 23S ribosomal RNA gene that confer high resistance to macrolides in M. pneumoniae were identified by DNA sequencing.Results. Among 202 M. pneumoniae isolates from M. pneumoniae-associated pneumonia patients, 176 (87.1%) were MRMP. Macrolide-resistant M. pneumoniae infection was significantly related to school age (P <. 01) and initial administration of macrolides (P <. 01). Minocycline or DOX (n = 125) or TFX or levofloxacin (n = 15) was used for definitive treatment of MRMP patients. Minocycline or DOX was significantly more effective than TFX (P ≤. 05) in achieving defervescence within 24 hours and in decreasing numbers of M. pneumoniae DNA copies 3 days after initiation.Conclusions. Macrolides are inappropriate as first-choice agents against MRMP in terms of shortening the clinical course and decreasing M. pneumoniae. Control and prevention of MRMP outbreaks in children require early decreases in M. pneumoniae as well as improvement of clinical findings.

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