Macrolide-resistant pneumonia linked to prolonged fever

Hsieh YC. Pediatr Infect Dis J. 2011;doi:10.1097/INF.0b013e318234597c.

One of the first documented pediatric patients with adult respiratory distress syndrome who had macrolide-resistant pneumonia holds some important lessons for clinicians, according to results of a study published online recently.

Yu-Chia Hsieh, MD, PhD, of the department of pediatrics, Chang Gung Children’s Hospital in Taoyuan, Taiwan, and colleagues said the patient — a 6-year-old girl — developed the symptoms around the same time as her 7-year-old brother. Both children had cough and rhinorrhea, and chest radiography taken at the time of hospital admission revealed opacity on the children’s lobes, as well as prolonged fever.

The researchers said macrolide-resistant Mycoplasma pneumoniae has been on the rise in Japan, China and some European countries in recent years, making effective antimicrobial treatment a paramount consideration, particularly in pediatric patients.

“In the siblings, high fever persisted and clinical deterioration developed, even after macrolide therapy. We observed that clinical conditions in the two cases improved after doxycycline treatment,” the researchers wrote in their report.

They said there were several limitations of the data, including that they could not completely exclude concomitant infection in the siblings and that no extensive immunologic workup was done for the siblings to study whether there was host-related factors that could explain their disease severity.

Regardless, the researchers concluded, “Our cases warrant more studies on the prevalence of macrolide-resistant M. pneumoniae and to evaluate the optimal treatment in severe cases of macrolide-resistant M. pneumoniae pneumonia.”

Disclosure: The researchers report no relevant financial disclosures.

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