Azithromycin Timing Not Associated With Childhood Mycoplasma Pneumonia Outcomes

mycoplasma pneumoniae
mycoplasma pneumoniae
Researchers assessed the timing of azithromycin administration for pediatric community-acquired pneumonia to determine its effectiveness in the setting of macrolide resistance.

Azithromycin therapy timing is not associated with Mycoplasma pneumoniae pneumonia clinical prognosis in children in high macrolide-resistant M pneumoniae prevalence settings, according to results published in PLoS One.

Dehua Yang of Zhejiang University School of Medicine, Hangzhou, China, and colleagues conducted a retrospective study to evaluate the clinical impact of azithromycin treatment timing in 623 children with M pneumoniae pneumonia. Children were divided into 2 groups: those who received azithromycin within 3 days of the onset of M pneumoniae pneumonia (early treatment group; n=174) and those who were treated more than 72 hours after symptom onset (late treatment group; n=449). The prevalence of macrolide-resistant M pneumoniae in Hangzhou is estimated to be nearly 90%.

Using medical records of children admitted to the Children’s Hospital, Zhejiang University School of Medicine in China from January 2011 to December 2014, the researchers evaluated clinical prognosis according to demographic, clinical, and laboratory characteristics. Although the early azithromycin treatment group had a longer fever duration after receiving azithromycin (7.17 days; P <.01), total fever duration exhibited no significant difference (9.02 vs 9.57 days; P =.212). Furthermore, there were no significant differences in improvements in laboratory and radiological findings (P >.05 for all).  

However, 28.41% of cases exhibited extrapulmonary complications, including myocardial damage, liver function abnormalities, and dermatologic damage. The early treatment group had significantly fewer extrapulmonary complications vs the late treatment group. The authors noted that an overreactive immune response is always present in M pneumoniae pneumonia, and azithromycin is reported to have immune regulation effects that may be beneficial in M pneumoniae pneumonia. These results seem to support that theory and suggest that azithromycin may help reduce extrapulmonary complications. 

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The authors concluded that azithromycin may be ineffective in treating macrolide-resistant M pneumoniae, but they were unable to withhold antibiotic treatment to confirm this hypothesis on ethical grounds. However, they did note that the early use of azithromycin helps to reduce extrapulmonary complications of M pneumoniae pneumonia. 


Yang D, Chen L, Chen Z. The timing of azithromycin treatment is not associated with the clinical prognosis of childhood Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings. PLoS One. 2018;13(1):e0191951.