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Jo: Wanted: The Best Second Option to Treat Macrolide-Unresponsive Mycoplasmal Pneumonia in Children
Editorial

Journal of Korean Medical Science 2018; 33(43): e281.

Published online: 10 October 2018

DOI: https://doi.org/10.3346/jkms.2018.33.e281

Wanted: The Best Second Option to Treat Macrolide-Unresponsive Mycoplasmal Pneumonia in Children

Dae Sun Jo

Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.

Address for Correspondence: Dae Sun Jo, MD, PhD. Department of Pediatrics, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Republic of Korea. drjo@chonbuk.ac.kr

Received 28 September 2018       Accepted 2 October 2018

© 2018 The Korean Academy of Medical Sciences.

The Korean Academy of Medical Sciences

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Mycoplasma pneumoniae is a major pathogen of community-acquired pneumonia in children and adolescents. Physicians may know the treatment of choice for childhood mycoplasmal pneumonia is macrolides.1 However, recently we have experienced so many beyond-textbook cases, i.e., macrolide-unresponsive mycoplasmal pneumonia.2 There have been many studies explaining why we should encounter these embarrassing patients: the most well-known is that the clever pathogens already acquired resistance by 23S rRNA mutation.3
Treating adult mycoplasmal infection, we have tetracyclines and quinolones as alternative antibiotic choices other than macrolides, but these are not recommended for use in children due to their potential side effects such as teeth staining and joint destruction, respectively. As the immune response of host is considered as an important mechanism of pathogenesis in symptomatic mycoplasmal infection, corticosteroids could readily be used in the management of severe pediatric cases, although their various side effects are also very well known: metabolic imbalance, growth disturbance, immunosuppression, and so on. Besides, there have been a few reports supporting beneficial clinical effect of immunomodulation, in other words, immunosuppression of corticosteroid in refractory mycoplasmal pneumonia in children.4
To date, however, second-line treatment of choice is not determined in the pediatric clinical setting where macrolides are not working. In this issue, Ha et al.5 reported the therapeutic efficacy comparisons among prolonged macrolide use, corticosteroids, doxycycline, and levofloxacin in the management of mycoplasmal pneumonia in children who had fever for more than 3 days even after macrolide treatment. In this retrospective clinical case based study, among the secondary treatment regimen groups (corticosteroids, doxycycline, and levofloxacin), the time to defervescence (TTD) was shortest in the corticosteroid treatment group. In addition, no side effects of these secondary regimens were found in this study. So, this study could reduce the hesitance of clinicians to prescribe corticosteroids. However, the TTD of each treatment regimen since the initial macrolide administration was not significantly different.
For firmer data to support the use of corticosteroid and/or other management regimen in mycoplasmal pneumonia in children, research should be performed in a prospective, blind manner, and with a more accurate diagnostic measure - another challenge in clinical studies dealing with childhood mycoplasmal infection.

Notes

Disclosure The author has no potential conflicts of interest to disclose.

References

1. Mejias A, Ramilo O. Chapter 223. Mycoplasma pneumoniae. In : Kliegman R, Stanton B, St Geme JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier;2016. p. 1487–1490.
2. Lee E, Cho HJ, Hong SJ, Lee J, Sung H, Yu J. Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children. Korean J Pediatr. 2017; 60(5):151–157.
3. Hong KB, Choi EH, Lee HJ, Lee SY, Cho EY, Choi JH, et al. Macrolide resistance of Mycoplasma pneumoniae, South Korea, 2000–2011. Emerg Infect Dis. 2013; 19(8):1281–1284.
4. You SY, Jwa HJ, Yang EA, Kil HR, Lee JH. Effects of methylprednisolone pulse therapy on refractory Mycoplasma pneumoniae pneumonia in children. Allergy Asthma Immunol Res. 2014; 6(1):22–26.
5. Ha SG, Oh KJ, Ko KP, Sun YH, Ryoo E, Tchah H, et al. Therapeutic efficacy and safety of prolonged macrolide, corticosteroid, doxycycline, and levofloxacin against macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children. J Korean Med Sci. 2018; 33(43):e268.
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ORCID iDs

Dae Sun Jo
https://orcid.org/0000-0002-3141-9539

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