Conclusion
CAP is a common condition in paediatric patients requiring admission
with M. pneumoniae a common causative pathogen. The current
recommended treatment for children with CAP suggests to add-on macrolide
to cover atypical bacterial pathogens on top of beta-lactam antibiotic
coverage if there is no response to first-line empirical therapy, or if
causative agent is compatible with atypical pathogens. However recent
reported resistance worldwide have demonstrated a large variation in
prevalence and we look at the local data for resistance trends in Hong
Kong. With a large and more comprehensive sample of data in this
extended study, we have observed a local resistance rate of 43% that is
significantly lower than the 75% previously published.
Patients in the MRMP group appeared to have a higher rate of developing
complications and requiring additional clinical support. Clinical
parameters and radiological changes did not show significant factors to
help differentiate clinically those likely with MRMP. TTD with a cut off
at 72hours showed a discriminative ability to identify those likely with
macrolide resistant mycoplasma pneumonia supporting the clinical
decision in early switch to doxycycline therapy particularly balancing
the risks of adverse effects in the younger population of children. This
would overall shorten the length of stay and decrease the burden of such
a common condition in the paediatric population to the overall health
care system in Hong Kong.
M. pneumoniae infection is considered a treatable disease with
significant burden to the paediatric population and therefore necessary
to give careful consideration to the appropriate antimicrobial therapy.
With increasingly reported resistance of M. pneumoniae in Asian
regions, there is a need for more widespread use of molecular methods to
confirm M. pneumoniae infection and to identify resistance in
order to provide further comprehensive data from our local population
for clearer perspective on MRMP in Hong Kong.
Conflicts of interest: None
Acknowledgements: Department of Pathology and Microbiology,
Tuen Mun Hospital
Funding : No funding was allocated for conducting this study.
Table 1.