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Comparison of Efficacy of Antimicrobial Agents Among Hospitalized Patients With Mycoplasma pneumoniae Pneumonia in Japan During Large Epidemics of Macrolide-Resistant M. pneumoniae Infections: A Nationwide Observational Study.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2017 Nov 13; Vol. 65 (11), pp. 1837-1842. - Publication Year :
- 2017
-
Abstract
- Background: Mycoplasma pneumoniae strains with resistance to macrolides have been spreading worldwide. Here, we aimed to clarify which antimicrobial agent is a better treatment for patients with M. pneumoniae pneumonia in a setting with large epidemics of macrolide resistance.<br />Methods: Adult patients hospitalized with laboratory-confirmed M. pneumoniae pneumonia from 2010 to 2013 were identified from the Japanese Diagnosis Procedure Combination national database. Drug switching, length of stay (LOS), 30-day mortality, and total costs for patients who underwent macrolide, quinolone, and tetracycline therapy were compared using propensity score analyses.<br />Results: Eligible patients (N = 1650) from 602 hospitals were divided into the macrolide group (n = 508), quinolone group (n = 569), or tetracycline group (n = 573). We found that 52.8%, 21.8%, and 38.6% of patients in the macrolide, quinolone, and tetracycline groups, respectively, had to switch drugs (P < .0001). There was no significant difference in the LOS and the 30-day mortality rates among these 3 groups. Cost was highest in the quinolone group (P = .0062). The propensity score-matched pairs (n = 487×2) generated from the quinolone and tetracycline groups also showed a lower proportion of patients who require switches in the quinolone group than in the tetracycline group (21.2% vs 39.6%, P < .0001) but not in the LOS, mortality, and cost.<br />Conclusions: There were no significant differences in the LOS and mortality among any antimycoplasmal drugs as initial treatment for hospitalized M. pneumoniae pneumonia patients despite the lower switching rate in the quinolone group.<br /> (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Subjects :
- Adult
Aged
Anti-Infective Agents administration & dosage
Anti-Infective Agents adverse effects
Anti-Infective Agents pharmacology
Databases, Factual
Epidemics
Female
Hospitalization
Humans
Japan epidemiology
Length of Stay
Macrolides administration & dosage
Macrolides adverse effects
Macrolides pharmacology
Male
Middle Aged
Mycoplasma pneumoniae genetics
Pneumonia, Mycoplasma diagnosis
Pneumonia, Mycoplasma epidemiology
Pneumonia, Mycoplasma mortality
Polymerase Chain Reaction
Quinolones administration & dosage
Quinolones adverse effects
Quinolones therapeutic use
RNA, Ribosomal, 23S
Tetracycline administration & dosage
Tetracycline adverse effects
Tetracycline therapeutic use
Anti-Infective Agents therapeutic use
Drug Resistance, Bacterial
Macrolides therapeutic use
Mycoplasma pneumoniae drug effects
Pneumonia, Mycoplasma drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 65
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 29020161
- Full Text :
- https://doi.org/10.1093/cid/cix695