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Moxifloxacin is safe for treating severe refractory M pneumoniae pneumonia

Contemporary PEDS JournalNovember/December 2023
Volume 40
Issue 10

Investigators asked the children’s parents about the history of musculoskeletal-related disease, observed the children’s gait, and performed physical examinations.

CImage Credit: Contemporary Pediatrics

CImage Credit: Contemporary Pediatrics


  • A retrospective study compared moxifloxacin and azithromycin in treating severe refractory Mycoplasma pneumoniae pneumonia (SRMPP) in children, finding no significant differences in clinical outcomes or imaging results.
  • Despite concerns about fluoroquinolones, the study concluded that moxifloxacin did not cause serious adverse events, including musculoskeletal issues and heart valve regurgitation (VR), in children treated for SRMPP.
  • Both moxifloxacin and azithromycin groups showed at least 80% of the expected height increment, indicating normal growth. Physical examinations and joint assessments did not reveal significant differences.
  • Clinical symptoms, such as effusion and knee pain, were similar in both treatment groups. Radiographs showed no obvious knee abnormalities, and imaging findings were comparable.
  • The study's overall conclusion was that moxifloxacin was well-tolerated and safe for treating SRMPP in children, offering reassurance about its use in pediatric cases where antibiotic resistance limits practical options.

A retrospective study of children treated for severe refractory Mycoplasma pneumoniae pneumonia (SRMPP) with the fluoroquinolone moxifloxacin and/or the antibiotic azithromycin found no statistically significant differences between these two treatments, either in clinical symptoms or findings on imaging.

Given that the FDA has warned that fluoroquinolones may cause serious adverse events, investigators focused on the correlation of these events, especially musculoskeletal issues and heart valve regurgitation (VR), with moxifloxacin. They concluded that the fluoroquinolone did not cause serious adverse events.

Investigators reviewed the medical records of 52 children with SRMPP who were treated at a Beijing, China, hospital during a 4-year period. Of the total group of 52 (31 boys and 21 girls), 31 children were in the moxifloxacin group and 21 in the azithromycin group. All participants had stopped treatment for at least a year.

Investigators asked the children’s parents about the history of musculoskeletal-related disease, observed the children’s gait, and performed physical examinations. They also evaluated the weight-bearing joint function and obtained x-rays of both knees to assess joint abnormality and pain and compared the children’s height at admission and follow-up to assess height growth.

Investigators also assessed VR using color Doppler ultrasound. They defined a serious adverse event as a musculoskeletal effect that affected daily living, a height gain of less than 80% of the expected value, and moderate to severe VR cardiac ultrasound.

Growth reached at least 80% of the expected height increment in both groups. Clinical symptoms were similar in the groups and included effusion and knee pain. But radiographs did not indicate any obvious knee abnormalities in either group or any statistically significant differences in imaging findings between the groups.

As for VR-related adverse events, no statistical difference was found in the incidence rate of VR before and after treatment, leading investigators to consider mild VR as “doubtfully related to moxifloxacin.” Based on these findings, investigators concluded that moxifloxacin was well tolerated and safe for treating SRMPP in children.


With antibiotic resistance rising, fluoroquinolones are becoming more valuable in pediatrics. This study, with its 1-year follow-up, is reassuring, but the numbers are not large enough to detect rare events. I am comfortable using the group short term when no other practical options are available, as can happen with some bladder infections, for example.


He YS, Yang M, Liu G, Ji J, Qian SY. Safety study of moxifloxacin in children with severe refractory Mycoplasma pneumoniae pneumonia. Pediatr Pulmonol. 2023;58(7):2017-2024. doi:10.1002/ppul.26426

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