Optimising Management of Macrolide-resistant Mycoplasma pneumoniae infections

1 September, 2017

Community-acquired pneumonia (CAP) is one of the most common infectious diseases worldwide. Although S. pneumoniae remains the most prevalent etiological pathogen, there has been increasing recognition of the atypical pathogen Mycoplasma pneumoniae in CAP infection. While prevalence reports differ in diagnostic criteria, it appears M. pneumoniae is responsible for 11% of CAP in Europe and up to 39% in the Asia-Pacific region. Until now macrolides have been the mainstay of therapy, however increasing resistance particularly in Asian countries means that these agents are no longer routinely effective.

Articles published in PubMed between 2000-2015 were reviewed to summarise the current situation in regard to M.pneumoniae pneumonia (MPP). Results confirmed that prior to 2000 few macrolide-resistant isolates were reported, but this has since increased with >80% found to be resistant in one Japanese 2012 study. Even more worryingly 69-95% of Chinese M. pneumoniaeisolates are reported to be macrolide resistant. In vitro studies have shown that resistance can rapidly develop following macrolide exposure due to point mutations in the 23S rRNA gene; this coupled with high levels of consumption have seen macrolide resistance skyrocket. Methods to overcome this resistance have included antibiotic stewardship, with a number of programs introduced worldwide restricting the use of macrolides. In 2011 the Chinese Ministry of Health launched a campaign to promote judicious use of antimicrobials. However these programs while reducing overall antibiotic sales have not been shown as yet to have an effect on reducing macrolide resistance.

Therefore alternative agents are required and pharmacokinetic and clinical data support the use of tetracyclines and fluoroquinolones in the treatment of MPP, including macrolide-resistant strains. While these classes of antimicrobials are not recommended in children, the report suggests that physicians treating children with macrolide-resistant CAP should assess the benefit/risks for each individual patient and that ultimately new antibiotics to treat MPP need to be developed.

PMID: 26365811

Clin Respir J. 2017 Jul;11(4):419-429. doi: 10.1111/crj.12379. Epub 2015 Oct 13.

Source: https://www.ncbi.nlm.nih.gov/pubmed/26365811?dopt=Abstract