Mechanism of resistance acquisition and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

Hyeon Jong Yang, Dae-Jin Song, Jung Yeon Shim

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006–2007, 2011, and 2015–2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80%–90%. Macrolide-resistant Mycoplasma pneumoniae (MRMP) harbors a point mutation in domain V of 23S rRNA with substitutions mainly detected at positions 2063 and 2064 of the sequence. The excessive use of macrolides may contribute to these mutations. MRMP can lead to clinically refractory pneumonia, showing no clinical or radiological response to macrolides, and can progress to severe and complicated pneumonia. Refractory MPP is characterized by an excessive immune response against the pathogen as well as direct injury caused by an increasing bacterial load. A change of antibiotics is recommended to reduce the bacterial load. Tetracyclines or quinolones can be alternatives for treating MRMP. Otherwise, corticosteroid or intravenous immunoglobulin can be added to the treatment regimen as immunomodulators to down-regulate an excessive host immune reaction and alleviate immune-mediated pulmonary injury. However, the exact starting time point, dose, or duration of immunomodulators has not been established. This review focuses on the mechanism of resistance acquisition and treatment options for MRMP pneumonia.

Original languageEnglish
Pages (from-to)167-174
Number of pages8
JournalKorean Journal of Pediatrics
Volume60
Issue number6
DOIs
Publication statusPublished - 2017 Jun 1

Fingerprint

Mycoplasma Pneumonia
Mycoplasma pneumoniae
Macrolides
Pneumonia
Therapeutics
Bacterial Load
Immunologic Factors
Tetracyclines
Intravenous Immunoglobulins
Quinolones
Lung Injury
Korea
Point Mutation
Disease Outbreaks
Adrenal Cortex Hormones
Down-Regulation
Anti-Bacterial Agents

Keywords

  • Child
  • Drug resistance
  • Macrolides
  • Mycoplasma pneumoniae
  • Pneumonia

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics

Cite this

Mechanism of resistance acquisition and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. / Yang, Hyeon Jong; Song, Dae-Jin; Shim, Jung Yeon.

In: Korean Journal of Pediatrics, Vol. 60, No. 6, 01.06.2017, p. 167-174.

Research output: Contribution to journalReview article

@article{48323398e755476d808ebddc7a1fa675,
title = "Mechanism of resistance acquisition and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children",
abstract = "Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006–2007, 2011, and 2015–2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80{\%}–90{\%}. Macrolide-resistant Mycoplasma pneumoniae (MRMP) harbors a point mutation in domain V of 23S rRNA with substitutions mainly detected at positions 2063 and 2064 of the sequence. The excessive use of macrolides may contribute to these mutations. MRMP can lead to clinically refractory pneumonia, showing no clinical or radiological response to macrolides, and can progress to severe and complicated pneumonia. Refractory MPP is characterized by an excessive immune response against the pathogen as well as direct injury caused by an increasing bacterial load. A change of antibiotics is recommended to reduce the bacterial load. Tetracyclines or quinolones can be alternatives for treating MRMP. Otherwise, corticosteroid or intravenous immunoglobulin can be added to the treatment regimen as immunomodulators to down-regulate an excessive host immune reaction and alleviate immune-mediated pulmonary injury. However, the exact starting time point, dose, or duration of immunomodulators has not been established. This review focuses on the mechanism of resistance acquisition and treatment options for MRMP pneumonia.",
keywords = "Child, Drug resistance, Macrolides, Mycoplasma pneumoniae, Pneumonia",
author = "Yang, {Hyeon Jong} and Dae-Jin Song and Shim, {Jung Yeon}",
year = "2017",
month = "6",
day = "1",
doi = "10.3345/kjp.2017.60.6.167",
language = "English",
volume = "60",
pages = "167--174",
journal = "Korean Journal of Pediatrics",
issn = "1783-1061",
publisher = "Korean Pediatric Society",
number = "6",

}

TY - JOUR

T1 - Mechanism of resistance acquisition and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

AU - Yang, Hyeon Jong

AU - Song, Dae-Jin

AU - Shim, Jung Yeon

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006–2007, 2011, and 2015–2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80%–90%. Macrolide-resistant Mycoplasma pneumoniae (MRMP) harbors a point mutation in domain V of 23S rRNA with substitutions mainly detected at positions 2063 and 2064 of the sequence. The excessive use of macrolides may contribute to these mutations. MRMP can lead to clinically refractory pneumonia, showing no clinical or radiological response to macrolides, and can progress to severe and complicated pneumonia. Refractory MPP is characterized by an excessive immune response against the pathogen as well as direct injury caused by an increasing bacterial load. A change of antibiotics is recommended to reduce the bacterial load. Tetracyclines or quinolones can be alternatives for treating MRMP. Otherwise, corticosteroid or intravenous immunoglobulin can be added to the treatment regimen as immunomodulators to down-regulate an excessive host immune reaction and alleviate immune-mediated pulmonary injury. However, the exact starting time point, dose, or duration of immunomodulators has not been established. This review focuses on the mechanism of resistance acquisition and treatment options for MRMP pneumonia.

AB - Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006–2007, 2011, and 2015–2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80%–90%. Macrolide-resistant Mycoplasma pneumoniae (MRMP) harbors a point mutation in domain V of 23S rRNA with substitutions mainly detected at positions 2063 and 2064 of the sequence. The excessive use of macrolides may contribute to these mutations. MRMP can lead to clinically refractory pneumonia, showing no clinical or radiological response to macrolides, and can progress to severe and complicated pneumonia. Refractory MPP is characterized by an excessive immune response against the pathogen as well as direct injury caused by an increasing bacterial load. A change of antibiotics is recommended to reduce the bacterial load. Tetracyclines or quinolones can be alternatives for treating MRMP. Otherwise, corticosteroid or intravenous immunoglobulin can be added to the treatment regimen as immunomodulators to down-regulate an excessive host immune reaction and alleviate immune-mediated pulmonary injury. However, the exact starting time point, dose, or duration of immunomodulators has not been established. This review focuses on the mechanism of resistance acquisition and treatment options for MRMP pneumonia.

KW - Child

KW - Drug resistance

KW - Macrolides

KW - Mycoplasma pneumoniae

KW - Pneumonia

UR - http://www.scopus.com/inward/record.url?scp=85021139722&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021139722&partnerID=8YFLogxK

U2 - 10.3345/kjp.2017.60.6.167

DO - 10.3345/kjp.2017.60.6.167

M3 - Review article

AN - SCOPUS:85021139722

VL - 60

SP - 167

EP - 174

JO - Korean Journal of Pediatrics

JF - Korean Journal of Pediatrics

SN - 1783-1061

IS - 6

ER -