The clinical efficacy of azithromycin combined with different-dose methylprednisolone therapy for refractory mycoplasma pneumoniae pneumonia in children
10.3760/cma.j.issn.1673-4408.2021.06.013
- VernacularTitle:不同剂量甲泼尼龙琥珀酸钠联合阿奇霉素治疗儿童难治性肺炎支原体肺炎的疗效观察
- Author:
Ying WU
1
;
Limin GUO
;
Qin YANG
;
Shipin FENG
Author Information
1. 电子科技大学医学院附属妇女儿童医院 成都市妇女儿童中心医院科教部 610000
- Keywords:
Children;
Refractory mycoplasma pneumoniae pneumonia;
Pulse therapy
- From:
International Journal of Pediatrics
2021;48(6):420-425
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of azithromycin combined with different-dose methylprednisolone therapy for refractory mycoplasma pneumoniae pneumonia(RMPP)in children.Methods:Two hundred and twenty cases of RMPP admitted to Chengdu Women′s and Children′s Central Hospital between January 2014 and December 2019 were selected.They were treated with azithromycin combined with 1~2 mg/(kg·d)(low-dose)of methylprednisolone for 3 days, then they were divided into 2 groups, 152 cases with effective treatment in the control group A(effective group), 68 cases with ineffective treatment in observation group B(ineffective group). Among group B, according to the IgG, IgM and IgA as defined in Zhu Futang Practice of Pediatrics, 45 cases with normal immunity named normal-immune group B, change methylprednisolone dose to 10~30 mg/(kg·d)(high-dose)for 3 days, and 23 cases with low immunity named weakened-immune group B, change methylprednisolone dose to 10~30 mg/(kg·d)for 3 days and give immunomodulator therapy, that is human immunoglobulin for intravenous injection(IVIG)200 mg/(kg·d)for 3 days.After treatment, duration of fever, lung inflammation, extrapulmonary complications, hospitalization days and other indicators were compared.Results:Comparison between group A and group B, the lung rale absorption time[(11.32±3.62)d vs(10.00±2.32)d], lung consolidation absorption rate(64.10% vs 83.33%), pulmonary atelectasis retentive rate(52.38% vs 82.60%), effusion absorption rate(66.67% vs 100.00% ), the incidence rate of extrapulmonary complications(38.82% vs 25.00%), the disappearance time of complications[(10.96±2.98)d vs(8.94±2.86)d], the average hospitalization stay[(12.30±3.56)d vs(11.25±3.84)d]were significantly different( P<0.05). Comparison between normal-immune group B and weakened-immune group B after giving high doses of methylprednisolone, the fever dropped time[(10.51±3.26)h vs(8.60±3.31)h], the lung rale absorption time[(10.51±2.24)d vs(9.00±2.19)d], lung consolidation absorption rate(72.00% vs 100.00%), the average hospitalization stay[(12.00±3.96)d vs(9.78±3.19)d]were significantly different( P<0.05). Conclusion:Compared to low-dose of methylprednisolone, azithromycin combined with high-dose methylprednisolone therapy is better for RMPP.For the children with weakened immunity, better curative effect was obtained by IVIG.
