Development of macrolide resistance-associated mutations after macrolide treatment in children infected with Free

Abstract

To determine the timing of the emergence of macrolide-resistant mutations after macrolide treatment in individuals with infections.

Between October 2011 and December 2013, serial pharyngeal swab specimens were collected before and after macrolide treatment from 21 otherwise healthy children infected with without macrolide-resistant mutations. The copy numbers of a gene and the proportion of clones showing macrolide-resistance mutations were determined for each specimen.

After macrolide treatment (10–15 mg kg day clarithromycin for 5–10 days or 10 mg kg day azithromycin for 3 days), fever resolved in 19 (90 %) of 21 children within 1 to 2 days, and the gene copy number decreased in all but one specimen in the second set of specimens relative to the number in the corresponding initial specimens. None of the second specimens, which were collected 2–4 days after initiation of macrolide treatment, showed mutations in the 23S rRNA gene. However, the proportion of mutant clones with A2063G and A2064G mutations in the specimens collected 7–24 days after initiation of treatment increased to 100 %. We identified a family in which three members had infections. The analysis of transmission in this household indicated that the harbouring a macrolide-resistant mutation that developed in the index patient after macrolide treatment was not transmitted to the family members.

A macrolide-resistant population might develop in individual patients up to 24 days after initiation of macrolide treatment. However, the decrease in load after macrolide administration effectively reduces interpersonal transmission.

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2017-11-01
2024-03-19
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