Emerging macrolide resistance in

Whooping cough, or pertussis, is a highly communicable infectious disease caused by the bacterium Bordetella pertussis. Vaccination once reduced the incidence of the disease, but a global resurgence of the infection happened during the past two decades, likely due to the waning immunity of vaccination. Macrolides such as erythromycin and azithromycin are the drugs of primary choice for treatment. In this personal view, we call for attention to macrolide-resistant B. pertussis (MRBP), which has emerged and prevailed in mainland China for years and are exclusively mediated by mutations in the 23S rRNA gene. Whether the prevalence of MRBP in China results from overuse of azithromycin in clinical medicine remains unknown. The incidence of MRBP is low in other countries, but this could be a technical illusion since China employs culture as the mainstream diagnostic method whereas nucleic-acid amplification test being widely used in other countries fail to test antimicrobial susceptibility. Given the increasingly frequent global travel that facilitates microbial transmission worldwide, there is a pressing need to perform international surveillance on MRBP to prevent the potential circulation of the organism. Finding alternative agents that possess good activity against B. pertussis is also urgently required.

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© 2021 The Authors.

Déclaration de conflit d'intérêts

Dr Feng declares no competing interests. During the conduct of the study, Dr. Chiu has received honoraria from Sanofi Pasteur, MSD, and Pfizer; Dr. Heininger and Dr. Hozbor have received honoraria from Sanofi Pasteur; Dr. von König has received honoraria from Sanofi Pasteur, GSK Biologicals SA, MSD, and Norvatis Vaccines. Dr. Tan has received grant from Sanofi Pasteur. Outside the submitted work, Dr. Tan has received grants from Merck, Pfizer, and Glaxo-Smith Kline.