Azitro

Correspondence: M. Haschke, Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. E-mail: HaschkeM@uhbs.ch Statement of Interest: None declared.

REFERENCES
1 Von Drygalski A, Curtis BR, Bougie DW, et al. Vancomycininduced immune thrombocytopenia. N Engl J Med 2007; 356: 904–910. 2 Documed. Product information dobutamineinjection. Arzbeunuttel Kompendium der Schweiz. [Swiss Compendium of Therapeutic Drugs.] www.documed.ch Date last updated: 2005. Date last accessed: December 1, 2009.

3 George JN, Raskob GE, Shah SR, et al. Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Int Med 1998; 129: 886–890. 4 Lee SH, Rubin LJ. Current treatment strategies for pulmonary arterial hypertension.J Intern Med 2005; 258: 199–215. 5 US Food and Drug Administration. Ventavis (iloprost) inhalation solution September 2008. MedWatch FDA Safety Information and Adverse Event Reporting Program. Date last updated: June 19, 2009. Date last accessed: December 1, 2009. 6 Uppsala Monitoring Centre World Health Organization collaborating Centre for International Drug Monitoring. VigiBaseTM Services.www.umc-products.com Date last accessed: December 1, 2009. 7 Chin KM, Channick RN, de Lemos JA, et al. Hemodynamics and epoprostenol use are associated with thrombocytopenia in pulmonary arterial hypertension. Chest 2009; 135: 130–136.
DOI: 10.1183/09031936.00011010

Azithromycin treatment failure in macrolide-resistant Mycoplasma pneumoniae pneumonia
To the Editors: Mycoplasma pneumoniae is oneof the most common bacterial causes of community-acquired pneumonia (CAP) [1]. Although most cases are mild, life-threatening diseases are also reported [2]. Clinical guidelines have recommended macrolides for treatment of community-acquired infection to target atypical organisms including M. pneumoniae [3] but there have been an increasing number of reports of macrolideresistant M. pneumoniaeisolated from clinical specimens [4]. Although there are studies suggesting poorer responses to macrolide in patients infected with macrolide-resistant strains, these are mainly limited to patients with mild disease. Here, we report a case of CAP due to macrolide-resistant M. pneumoniae with poor response to azithromycin but rapid resolution after tigecycline. In October 2009, a 24-yr-old female wasadmitted to our hospital with a 4-day history of fever, sore throat, cough and myalgia, associated with nausea, vomitting and diarrhoea. 2 months before admission, she was hospitalised for acute pyelonephritis due to Escherichia coli. Otherwise, her past health was unremarkable. She traveled to Xi’an, China, for 7 days and returned to Hong Kong 10 days before the onset of symptoms. While in Xi’an,she stayed with her father, who had an episode of suspected respiratory tract infection, presenting with cough and sputum. 2 days before admission, she attended the accident and emergency department of a regional hospital in Hong Kong SAR (China). A chest radiograph showed right middle zone consolidation (fig. 1a). Her temperature was 39.4uC, blood pressure was 101/57 mmHg, pulse was 111beats?min-1, respiratory rate was 16 breaths?min-1 and oxygen saturation was 98% while breathing ambient air. She was discharged with amoxicillin–clavulanate (1,000 mg twice daily) and paracetamol. Because of persistent symptoms 1 day before admission,
EUROPEAN RESPIRATORY JOURNAL

azithromycin (500 mg once daily) and oseltamivir (75 mg twice daily) were added as treatment for CAP. RT-PCR ofnasopharyngeal aspirate for influenza, collected 1 day before

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FIGURE 1.

Radiographical findings. a) Chest radiograph taken 2 days before

admission, showing right middle zone consolidation. b) Chest radiograph on 7th day of hospitalisation, showing progression of consolidation. c) Computed tomography on 7th day of hospitalisation, showing right lower lobe consolidation with...