Therapeutic efficacy of azithromycin, clarithromycin, minocycline and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients

Objective: To clarify therapeutic effects of azithromycin, clarithromycin, minocycline and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia and against macrolide-sensitive Mycoplasma pneumoniae (MSMP) pneumonia in pediatric patients. Methods: A prospective, multicenter observational study was conducted from July 2013 to August 2015. The therapeutic effects of azithromycin, clarithromycin, minocycline and tosufloxacin were evaluated in 59 patients with pneumonia caused by MRMP and in 50 patients with pneumonia caused by MSMP. In vitro activities of antimicrobial agents against isolates of Mycoplasma pneumoniae were also measured. Results: Mean durations of fever following commencement of treatment in patients infected with MRMP and MSMP were 5.2 and 1.9 days, respectively (log-rank test, P < 0.0001). Among patients infected with MRMP, mean durations of fever were 4.6, 5.5, 1.0 and 7.5 days for patients treated with azithromycin, clarithromycin, minocycline and tosufloxacin, respectively (log-rank test, P < 0.0001). Among patients infected with MSMP, mean durations of fever were 2.5, 1.7, 0.9 and 4.3 days for patients treated with azithromycin, clarithromycin, minocycline and tosufloxacin, respectively (log-rank test, P = 0.0162). The MIC90s of azithromycin and clarithromycin among the 27 isolates of MRMP were 64 and 256 μg/ml, respectively, and those among the 23 isolates of MSMP were <0.000125 and 0.001 μg/ml, respectively. The MIC90s of minocycline and tosufloxacin among the 27 isolates of MRMP were 1.0 and 0.25 μg/ml, respectively, and those among the 23 isolates of MSMP were 1.0 and 0.5 μg/ml, respectively. Conclusion: Both minocycline and tosufloxacin showed good in vitro activities against MRMP. Minocycline, but not tosufloxacin, shortened the duration of fever in pediatric patients infected with MRMP compared to the duration of fever in patients treated with macrolides

Clinical effectiveness of four neuraminidase inhibitors (oseltamivir, zanamivir, laninamivir, and peramivir) for children with influenza A and B in the 2014-2015 to 2016-2017 influenza seasons in Japan

The clinical effectiveness of four neuraminidase inhibitors (NAIs) (oseltamivir, zanamivir, laninamivir, and peramivir) for children aged 0 months to 18 years with influenza A and B were investigated in the 2014-2015 to 2016-2017 influenza seasons in Japan. A total of 1207 patients (747 with influenza A and 460 with influenza B) were enrolled. The Cox proportional-hazards model using all of the patients showed that the duration of fever after administration of the first dose of the NAI was shorter in older patients (hazard ratio = 1.06 per 1 year of age, p < 0.001) and that the duration of fever after administration of the first dose of the NAI was shorter in patients with influenza A infection than in patients with influenza B infection (hazard ratio = 2.21, p < 0.001). A logistic regression model showed that the number of biphasic fever episodes was 2.99-times greater for influenza B-infected patients than for influenza A-infected patients (p < 0.001). The number of biphasic fever episodes in influenza A-or B-infected patients aged 0-4 years was 2.89-times greater than that in patients aged 10-18 years (p = 0.010), and the number of episodes in influenza A-or B-infected patients aged 5-9 years was 2.13times greater than that in patients aged 10-18 years (p = 0.012)

Results of analysis using the Cox proportional hazards model to determine factors influencing duration of fever following commencement of treatment.

<p>Results of analysis using the Cox proportional hazards model to determine factors influencing duration of fever following commencement of treatment.</p

<i>In vitro</i> anti-mycoplasma activities against clinical isolates of <i>M</i>. <i>pneumoniae</i> with or without A2063G mutation in the 23S rRNA gene.

<p><i>In vitro</i> anti-mycoplasma activities against clinical isolates of <i>M</i>. <i>pneumoniae</i> with or without A2063G mutation in the 23S rRNA gene.</p

Durations of fever following commencement of treatment for pneumonia due to MRMP and MSMP.

<p>Histograms showing the durations of fever following commencement of treatment for pneumonia due to MRMP (black bar) and pneumonia due to MSMP (white bar).</p

Differences between fever durations in the MRMP and MSMP groups following commencement of treatment with azithromycin, clarithromycin, minocycline and tosufloxacin.

<p>Kaplan–Meier curves showing a comparison of times taken for body temperature to return to <37.5°C among patients infected with MRMP and patients infected with MSMP who were treated with (A) any of the antibiotics (log-rank test, <i>P</i> < 0.0001), (B) azithromycin (log-rank test, <i>P</i> = 0.0175), (C) clarithromycin (log-rank test, <i>P</i> < 0.0001), (D) minocycline (log-rank test, <i>P</i> = 0.7496) and (E) tosufloxacin (log-rank test, <i>P</i> = 0.3166).</p