Pneumonia in pregnancy is associated with adverse maternal and foetal outcomes, and intensive treatment with appropriate
antibiotics is essential. However, cases caused by pathogens that are resistant to
antibiotics suitable for the developing foetus are challenging. We herein report a case of
macrolide-refractory Mycoplasma pneumoniae
pneumonia in pregnancy. A 40-year-old multigravida with twin pregnancy complained of
cough and
fever at 13 weeks of gestation and was diagnosed with
pneumonia. Even though empiric treatment with
ceftriaxone and oral
azithromycin was started, her condition deteriorated rapidly. The findings of chest computed tomography suggested Mycoplasma pneumoniae
pneumonia. Since
azithromycin did not work, this strain was considered to be
macrolide-refractory.
Garenoxacin, an oral
quinolone, was selected and was dramatically effective. The use of
quinolone could be justified with the emergence of
drug-resistant bacterial/atypical
pneumonia and in the maternal life-threatening condition.