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      Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment

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          Abstract

          Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults. These infections occur both endemically and epidemically worldwide. M. pneumoniae lacks cell wall and is subsequently resistant to beta-lactams and to all antimicrobials targeting the cell wall. This mycoplasma is intrinsically susceptible to macrolides and related antibiotics, to tetracyclines and to fluoroquinolones. Macrolides and related antibiotics are the first-line treatment of M. pneumoniae respiratory tract infections mainly because of their low MIC against the bacteria, their low toxicity and the absence of contraindication in young children. The newer macrolides are now the preferred agents with a 7-to-14 day course of oral clarithromycin or a 5-day course of oral azithromycin for treatment of community-acquired pneumonia due to M. pneumoniae, according to the different guidelines worldwide. However, macrolide resistance has been spreading for 15 years worldwide, with prevalence now ranging between 0 and 15% in Europe and the USA, approximately 30% in Israel and up to 90–100% in Asia. This resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides. Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens. Because this resistance has clinical outcomes such as longer duration of fever, cough and hospital stay, alternative antibiotic treatment can be required, including tetracyclines such as doxycycline and minocycline or fluoroquinolones, primarily levofloxacin, during 7–14 days, even though fluoroquinolones and tetracyclines are contraindicated in all children and in children < 8 year-old, respectively. Acquired resistance to tetracyclines and fluoroquinolones has never been reported in M. pneumoniae clinical isolates but reduced susceptibility was reported in in vitro selected mutants. This article focuses on M. pneumoniae antibiotic susceptibility and on the development and the evolution of acquired resistance. Molecular detection of resistant mutants and therapeutic options in case of macrolide resistance will also be assessed.

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          Most cited references86

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          The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

          Abstract Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
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            British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011.

            The British Thoracic Society first published management guidelines for community acquired pneumonia in children in 2002 and covered available evidence to early 2000. These updated guidelines represent a review of new evidence since then and consensus clinical opinion where evidence was not found. This document incorporates material from the 2002 guidelines and supersedes the previous guideline document.
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              Guidelines for the management of adult lower respiratory tract infections - Full version

              This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. Background sections and graded evidence tables are also included. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.
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                Author and article information

                Contributors
                Journal
                Front Microbiol
                Front Microbiol
                Front. Microbiol.
                Frontiers in Microbiology
                Frontiers Media S.A.
                1664-302X
                22 June 2016
                2016
                : 7
                : 974
                Affiliations
                [1] 1USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, Univ. Bordeaux Bordeaux, France
                [2] 2USC EA 3671 Mycoplasmal and Chlamydial Infections in Humans, INRA Bordeaux, France
                [3] 3Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Bordeaux Bordeaux, France
                Author notes

                Edited by: Thomas Dandekar, University of Würzburg, Germany

                Reviewed by: Paras Jain, Albert Einstein College of Medicine, USA; Pio Maria Furneri, University of Catania, Italy; Masayuki Saijo, National Institute of Infectious Diseases, Japan; Bruno Pozzetto, University Jean Monnet of Saint-Etienne, France

                *Correspondence: Sabine Pereyre sabine.pereyre@ 123456u-bordeaux.fr

                This article was submitted to Infectious Diseases, a section of the journal Frontiers in Microbiology

                Article
                10.3389/fmicb.2016.00974
                4916212
                27446015
                55266e1d-4349-4574-9cee-6ceec7cd7c7a
                Copyright © 2016 Pereyre, Goret and Bébéar.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 13 February 2016
                : 06 June 2016
                Page count
                Figures: 1, Tables: 2, Equations: 0, References: 93, Pages: 11, Words: 8047
                Categories
                Public Health
                Mini Review

                Microbiology & Virology
                mycoplasma pneumoniae,macrolides,resistance,molecular detection,treatment
                Microbiology & Virology
                mycoplasma pneumoniae, macrolides, resistance, molecular detection, treatment

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