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.