{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:02:06Z","timestamp":1784721726725,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the efficacy and short-term safety of omadacycline as second-line therapy for macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children aged 8\u201316 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 64 hospitalized children with MUMPP admitted between September 2023 and December 2024 were enrolled. Children with persistent fever (&amp;gt;38.0\u00a0\u00b0C) after 72 hours of azithromycin monotherapy were assigned to receive intravenous omadacycline (n=18) or continued azithromycin (n=46). Omadacycline was dosed according to body surface area (BSA)-based scaling from the approved adult regimen (loading dose on day 1; maintenance dose once daily for 7 days). Primary outcome: time to defervescence (TTD). Secondary outcomes: 72-hour defervescence rate, radiological improvement, corticosteroid use, and adverse events. Three-month follow-up included dental examinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Omadacycline achieved shorter TTD than continued macrolides (50.78\u00a0\u00b1\u00a020.71 vs. 72.46\u00a0\u00b1\u00a025.61 hours; P\u00a0=\u00a00.002) and higher 72-hour defervescence rate (55.6% vs. 26.1%; P\u00a0=\u00a00.026). On multivariate linear regression, continued macrolide therapy (B\u00a0=\u00a013.43 h, 95% CI: 2.02\u201324.84, P\u00a0=\u00a00.022), positive 23S rRNA mutation status (B\u00a0=\u00a020.85 h, 95% CI: 10.94\u201330.77, P&amp;lt;0.001), and systemic corticosteroid use (B\u00a0=\u00a021.21 h, 95% CI: 10.79\u201331.62, P&amp;lt;0.001) were independently associated with prolonged TTD. No significant difference was observed in radiological improvement (P\u00a0=\u00a00.668). Corticosteroid requirement was significantly lower in the omadacycline group than in the macrolide group (27.8% vs. 67.4%; P\u00a0=\u00a00.004). Adverse events were comparable (5.6% vs. 8.7%; P\u00a0=\u00a00.645). At 3-month follow-up, no clinically significant changes were observed in hematological indices, hepatic or renal function, or cardiac enzyme profiles, and dental examination revealed no discoloration or enamel hypoplasia in any patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective cohort, omadacycline as second-line therapy was associated with significantly faster fever resolution than continued macrolide treatment, with acceptable short-term safety profiles over a 3-month follow-up. Prospective randomized trials are needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1863784","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:13:07Z","timestamp":1784718787000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and short-term safety of intravenous omadacycline as second-line therapy for macrolide- unresponsive Mycoplasma pneumoniae pneumonia in children: a retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Yang","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Nanjing Lishui People\u2019s Hospital, Zhongda Hospital Lishui Branch, Southeast University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nanjing Lishui People\u2019s Hospital, Zhongda Hospital Lishui Branch, Southeast University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nanjing Lishui People\u2019s Hospital, Zhongda Hospital Lishui Branch, Southeast University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nanjing Lishui People\u2019s Hospital, Zhongda Hospital Lishui Branch, Southeast University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3636","article-title":"Assessment of musculoskeletal toxicity 5 years after therapy with levofloxacin","volume":"134","author":"Bradley","year":"2014","journal-title":"Pediatrics"},{"key":"B2","doi-asserted-by":"publisher","first-page":"394","DOI":"10.15585\/mmwr.mm7423a1","article-title":"Mycoplasma pneumoniae infections in hospitalized children - United States, 2018-2024","volume":"74","author":"Diaz","year":"2025","journal-title":"MMWR. 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