Several studies regarding infections caused by macrolide-resistant Mycoplasma pneumoniae have been reported in the last years in the United States, where the prevalence is approximately 10% but may range from 3% to even 80%. Macrolide-resistant M. pneumoniae may be associated with prolonged fever, hospital stay, and complications. Suspicion should be raised by non-response to macrolides, and detection can be achieved through routine reflexive testing of M. pneumoniae-positive specimens with a polymerase-chain reaction assay that rapidly predicts macrolide resistance. After timely initiation of an alternative antibiotic, prompt resolution of the disease is likely in most cases. This review summarizes current US data, offers some suggestions, and identifies knowledge gaps on this infection.
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