Resistant Mycoplasma pneumoniae in children.

QUESTION: A 5-year-old child was seen in our clinic with a clinical presentation consistent with community-acquired pneumonia. She was prescribed a course of amoxicillin and azithromycin, but remained febrile and returned to the clinic 3 days later. The family just returned from a trip to Japan. What is the current available evidence for treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia?

ANSWER: Macrolide-resistant M pneumoniae (MRMP) rates are increasing worldwide, with especially high prevalence in China, Japan, and Taiwan. Most evidence in children supports the use of tetracyclines for MRMP with more limited evidence supporting fluoroquinolones for this indication. Children with M pneumoniae pneumonia and a history of recent travel to countries with high rates of resistance or who do not improve within 48 to 72 hours of macrolide treatment should be treated with 2 mg/kg of doxycycline orally twice daily (maximum 100 mg per dose).