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China - Zhejiang U Children's Hospital warns on drug resistance in mycoplasma pneumonia treatment - October 23, 2024

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  • China - Zhejiang U Children's Hospital warns on drug resistance in mycoplasma pneumonia treatment - October 23, 2024

    A 6-year-old girl has repeated fever and has not recovered after 20 days of treatment. Be alert to mycoplasma pneumonia

    2024-10-23 16:10
    Zhejiang
    Source: The Paper · The Paper · Paike

    Original Trend News, Publicity Center Zhejiang University Children's Hospital
    Mycoplasma pneumonia is already an "old acquaintance". In the past two years, many children and parents have suffered from it, especially those who have not been treated well and have developed severe symptoms. Not only is the process particularly tortuous, but the damage to the body is also great...
    Mycoplasma pneumonia in a 6-year-old girl
    I can't control it
    Escorted by ambulance to Zhejiang University Children's Hospital

    Six-year-old An An (pseudonym) is such a child with a recurring and extremely complicated disease course.
    About ten days ago, she was transferred to the National Clinical Research Center for Child Health and Disease, the National Children's Regional Medical Center, and the Children's Hospital Affiliated to Zhejiang University School of Medicine (hereinafter referred to as Zhejiang University Children's Hospital) under the escort of a local ambulance. Before arriving at Zhejiang University Children's Hospital, she had actually been receiving treatment in a local hospital for the past twenty days.
    It turns out that the child suffered from false negatives and drug resistance

    The disease recurred repeatedly, and a large area of ​​the lungs turned white.
    Why can’t this child’s Mycoplasma pneumonia be controlled?
    Huang Meixia, deputy chief physician of the respiratory department of Zhejiang University Children's Hospital, said that the child had a fever at first. After about three or four days of fever, he went to the local hospital for treatment. He did a mycoplasma nucleic acid test, which showed negative. The doctor first considered it a bacterial infection and prescribed cephalosporin and cough suppressants. Unexpectedly, the child still had a high fever after returning home, and the antipyretics could not suppress it. After another day or two, the child went to the hospital again. After further examination, the doctor found that the child's lung inflammation was already quite obvious, so he was admitted to the hospital. During the hospitalization, it was confirmed that it was Mycoplasma pneumonia. Azithromycin was infused, but it was still out of control. Later, drug resistance was suspected, and hormones and doxycycline were soon used. However, she still had repeated high fever and severe cough, and her lung condition further deteriorated. The local hospital also performed a bronchoscopy on her. Later, the inflammation was still very serious and the body temperature was still repeated.
    "When the patient was transferred, one side of the lung still had obvious consolidation and atelectasis, which is what we often call white lung," Huang Meixia added.
    Why is the child’s condition getting worse despite active treatment?
    Huang Meixia analyzed: Although the child received timely treatment, the early treatment effect was not significant because of drug resistance. In addition, due to false negatives, the diagnosis was delayed, causing her to miss the best window for treatment.
    Fortunately, after the child came to Zhejiang University Children's Hospital, he received comprehensive diagnosis and treatment from a super team. Huang Meixia and her colleagues quickly adjusted the treatment plan, including adjusting the dose and frequency of hormone drugs, and performed bronchoscopic alveolar lavage again. In less than three days, the body temperature stabilized. After less than 10 days of hospitalization, he was discharged and returned home.
    Doctors warn against false negatives:
    Even if the test is negative,
    Don't take it lightly!
    In Huang Meixia's opinion, children like An An whose illness recurs repeatedly are not uncommon in clinical practice.
    "Early antibody tests for Mycoplasma pneumonia can be negative, and nucleic acid tests can also show false negatives. Some children only have high fever in the early stage, and the cough is not obvious. Later, when a chest X-ray is taken, it will show that they have pneumonia. Therefore, even if the child is sent to the doctor in time after two or three days of fever, it is difficult for some children to be cured, because if it is a false negative for mycoplasma, the first treatment considered at the beginning will not be the treatment for Mycoplasma pneumonia, and the effect will not be so significant. If the child is infected with drug-resistant Mycoplasma, the effect will be even more discounted.
    "Most children with Mycoplasma pneumonia have mild symptoms and do not need to be hospitalized. Their condition can be closely monitored. However, a small number of children do have a rapid and dangerous course of disease. If they are not treated in time, they will have complications and sequelae after Mycoplasma pneumonia, and some may even require surgical intervention."
    Huang Meixia said that the focus of Mycoplasma pneumonia is early identification and treatment of severe Mycoplasma pneumonia, and the best treatment window is within 5 to 10 days after fever. If your child has persistent fever and severe cough, you should go to the hospital in time to determine whether it is Mycoplasma pneumonia infection. Even if you go to the hospital in the early stage of fever and the Mycoplasma pneumonia test is negative, you should not take it lightly, because Mycoplasma pneumonia antibodies can be negative in the early stage, and nucleic acid tests may also be false negative. Doctors need to make judgments based on the child's condition.
    Doctors also remind people to be vigilant about drug resistance:
    Fever recurred after taking azithromycin.
    Be alert
    In addition to false negatives, many parents are also very concerned about drug resistance, fearing that the occasional phenomena mentioned in the news will really happen to them.
    In this regard, Huang Meixia said that the problem of Mycoplasma pneumoniae showing "resistance" to the macrolide antibiotic azithromycin has always existed. In fact, data show that in our country, the resistance rate of Mycoplasma pneumoniae isolated from pediatric patients to azithromycin is between 60% and 90% in most regions, and there are differences in different regions in the country. The resistance of drugs, such as azithromycin, has nothing to do with whether it is imported or domestically produced.
    Mycoplasma pneumonia may still have recurrent fever after using azithromycin. On the one hand, it may be due to resistance to macrolides. On the other hand, it may be because some children have a strong inflammatory response after being infected with mycoplasma.
    For children with Mycoplasma pneumoniae who do not respond well to azithromycin, doctors should adjust the treatment plan according to the condition. For children over 8 years old, new tetracyclines, such as doxycycline, can be used. However, the use of new tetracyclines in children under 8 years old is considered "off-label use" and must be used with the informed consent of the patient's family.
    "Currently, oral doxycycline is a more commonly used method." Huang Meixia said that tetracycline drugs may cause yellowing of teeth and poor development of tooth enamel, "but these mostly occur after long-term and repeated use. And the current new tetracycline drugs have reduced ability to bind to teeth, so the chance of adverse reactions is even smaller."
    Huang Meixia also reminded parents that children with Mycoplasma pneumoniae like An An can also be treated with hormones during treatment. Mycoplasma infection will produce a strong inflammatory response, and hormones can inhibit the body's inflammatory response, which is the most critical. Moreover, most hormone treatment courses are relatively short, so parents do not need to worry too much about the side effects of hormones.
    "During this period, as the seasons change, in addition to Mycoplasma pneumoniae, various viruses also begin to become prevalent, including respiratory syncytial virus, metapneumovirus, parainfluenza virus, boca virus, rhinovirus, etc. Infants and young children under 2 years old are most susceptible to the infection, and generally show symptoms such as coughing, wheezing, low fever or no fever. Parents should also take precautions," said Huang Meixia.
    Source: Chao News
    Original title: "A 6-year-old girl has repeated fevers and has not recovered after 20 days of treatment... Doctor: Beware of Mycoplasma pneumonia! Beware of false negatives and drug resistance!"


    z​https://www.thepaper.cn/newsDetail_forward_29119903
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