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Drug ineffective: case report A 26-year-old man exhibited ineffectiveness with azithromycin, levofloxacin, moxifloxacin and methylprednisolone, while being treated for severe fulminant Mycoplasma pneumoniae pneumonia (MPP) [not all dosages and routes stated]. The man presented to a clinic on 21 April 2017 with high temperature of 39°C and non-productive cough for duration of one day. He started receiving treatment with levofloxacin 0.6g once daily infusion; however, his symptoms showed no improvement after 5 days of therapy. On day 6, he experienced severe cough along with wheezing following exertion. On day 7, his LDH level was found to be 450 U/L. Chest CT scan showed consolidation in the left upper lung lobe. Subsequently, he received azithromycin infusion with methylprednisolone 40mg once daily for 6 days. However, his fever persisted and the wheezing worsened. Chest CT scan revealed an expanded area of consolidation. Therefore, he was transferred to the hospital on day 13. On admission, he also received treatment with moxifloxacin 400mg once daily along with meropenem for 3 days. Despite, moxifloxacin and meropenem treatment, his body temperature increased to 40.0°C and oxygen saturation decreased continuously after admission. The treatment with azithromycin, levofloxacin, moxifloxacin and methylprednisolone proved ineffective. On admission day 3, bronchoscopy was performed. Bronchoalveolar lavage fluid was screened for common respiratory pathogens, which showed no pathogen except for Mycoplasma pneumoniae. Based on these findings, a diagnosis of severe fulminant MPP was made. Due to the ineffectiveness azithromycin, levofloxacin, moxifloxacin and methylprednisolone in the treatment of MPP, he was treated with tigecycline on admission day 4. As a result, his fever subsided within 24 hour. After 4 days of tigecycline therapy, his symptoms rapidly resolved and lung infiltration improved. Therefore, he was discharged from the hospital. After discharge, he received minocycline for 10 days. On follow-up one month after discharge, he was found to be asymptomatic. Chest CT performed 21 days after discharge showed limited features of bronchiolitis in the left lung. Yuan X, et al. Tigecycline in the treatment of fulminant Mycoplasma pneumoniae pneumonia non-responsive to azithromycin and fluoroquinolone: A case report. Medicine 803496924 99: No. 28, 10 Jul 2020. Available from: URL: http://doi.org/10.1097/MD.0000000000021128

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Reactions 22 Aug 2020 No. 1818