Yang Hyeon-Jong
Pediatric Allergy and Respiratory Center, Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
Korean J Pediatr. 2019 Jun;62(6):199-205. doi: 10.3345/kjp.2018.07367. Epub 2019 Mar 15.
Although Mycoplasma pneumoniae pneumonia (MPP) has been generally susceptible to macrolides, the emergence of macrolide-resistant MPP (MRMP) has made its treatment challenging. MRMP rapidly spread after the 2000s, especially in East Asia. MRMP is more common in children and adolescents than in adults, which is likely related to the frequent use of macrolides for treating M. pneumoniae infections in children. MRMP is unlikely to be related to clinical, laboratory, or radiological severity, although it likely prolongs the persistence of symptoms and the length of hospital stay. Thereby, it causes an increased burden of the disease and poor quality of life for the patient as well as a societal socioeconomic burden. To date, the only alternative treatments for MRMP are secondary antimicrobials such as tetracyclines (TCs) or fluoroquinolones (FQs) or systemic corticosteroids; however, the former are contraindicated in children because of concerns about potential adverse events (i.e., tooth discoloration or tendinopathy). A few guidelines recommended TCs or FQs as the second-line drug of choice for treating MRMP. However, there have been no evidence-based guidelines. Furthermore, safety issues have not yet been resolved. Therefore, this article aimed to review the benefits and risks of therapeutic alternatives for treating MRMP in children and review the recommendations of international or regional guidelines and specific considerations for their practical application.
尽管肺炎支原体肺炎（MPP）通常对大环内酯类药物敏感，但耐大环内酯类MPP（MRMP）的出现使其治疗具有挑战性。MRMP在21世纪初后迅速传播，尤其是在东亚地区。MRMP在儿童和青少年中比在成人中更常见，这可能与儿童肺炎支原体感染频繁使用大环内酯类药物有关。MRMP不太可能与临床、实验室或影像学严重程度相关，尽管它可能会延长症状持续时间和住院时间。因此，它会增加疾病负担，降低患者生活质量，并造成社会经济负担。迄今为止，MRMP唯一的替代治疗方法是四环素（TCs）或氟喹诺酮类（FQs）等二线抗菌药物或全身用糖皮质激素；然而，由于担心潜在的不良事件（即牙齿变色或肌腱病），前者在儿童中禁用。一些指南推荐TCs或FQs作为治疗MRMP的二线首选药物。然而，尚无循证指南。此外，安全性问题尚未得到解决。因此，本文旨在综述儿童MRMP治疗替代方案的益处和风险，回顾国际或地区指南的建议及其实际应用的具体考量。
