Azithromycin to doxycycline switching in children with Mycoplasma pneumoniae pneumonia resistance gene positivity

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Frontiers in Medicine Published April 30, 2026 Medically reviewed May 1, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note the high 91.3% macrolide resistance gene positivity rate in children with Mycoplasma pneumoniae pneumonia.

This retrospective cohort study included 150 children with Mycoplasma pneumoniae pneumonia who underwent resistance gene testing at two centers: Affiliated Hospital of North Sichuan Medical College and People's Hospital of Nanbu County. The study assessed Mycoplasma pneumoniae resistance gene expression, comparing positive and negative groups, and evaluated the switch from azithromycin to doxycycline.

Results showed that 137 out of 150 children, or 91.3%, were positive for the macrolide resistance gene. Significant differences were observed between the groups regarding baseline characteristics, inflammatory markers, disease severity, and clinical management, with a p-value reported as P < [truncated in source]. Secondary outcomes analyzed included age, CRP, PCT, lymphocyte count, severe MPP, pleural effusion, bronchoscopy, peak fever, hospital stay, and antibiotic duration.

Safety and tolerability data, including adverse events and discontinuation rates, were not reported. Because this is a retrospective cohort study, the findings identify factors associated with switching antibiotics using multivariate logistic regression but do not establish causation. Clinicians should consider resistance gene detection as a potential tool for identifying predictors for antibiotic adjustment, though the evidence remains observational.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundThis study aimed to evaluate whether Mycoplasma pneumoniae resistance gene detection can independently guide antibiotic therapy for Mycoplasma pneumoniae pneumonia in children and to identify key predictors for antibiotic adjustment.MethodsWe conducted a retrospective cohort study of children with Mycoplasma pneumoniae pneumonia who underwent resistance gene testing. Participants were recruited from two centers (Affiliated Hospital of North Sichuan Medical College and People's Hospital of Nanbu County) between January 2023 and October 2025. Resistance gene testing results served as the basis for assigning patients to either the positive or negative group. The expression of Mycoplasma pneumoniae resistance genes was analyzed. The positive group was further divided into a “switch group” (switched to doxycycline) and a “maintenance group” (continued azithromycin). We performed a comparative analysis of demographic, clinical, and laboratory parameters across the groups. Multivariate logistic regression identified factors associated with switching antibiotics, and ROC curves assessed predictive performance.ResultsA total of 150 children were enrolled, with 13 in the macrolide resistance gene-negative group and 137 in the positive group, resulting in a macrolide resistance gene positivity rate of 91.3%. Of these patients, 65 patients were in the switch group and 72 patients were in the maintenance group. Significant differences were observed in baseline characteristics (age), inflammatory markers (CRP, PCT, lymphocyte count), disease severity (severe MPP, pleural effusion, bronchoscopy), and clinical management (peak fever, hospital stay, antibiotic duration) (P