Therapeutic Efficacy and Safety of Prolonged Macrolide, Corticosteroid, Doxycycline, and Levofloxacin against Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children.
10.3346/jkms.2018.33.e268
- Author:
Seok Gyun HA
1
;
Kyung Jin OH
;
Kwang Pil KO
;
Yong Han SUN
;
Eell RYOO
;
Hann TCHAH
;
In Sang JEON
;
Hyo Jeong KIM
;
Jung Min AHN
;
Hye Kyung CHO
Author Information
1. Department of Pediatrics, Gachon University College of Medicine, Incheon, Korea.
- Publication Type:Original Article
- Keywords:
Antibiotics;
Mycoplasma pneumoniae;
Pneumonia
- MeSH:
Adrenal Cortex Hormones;
Anti-Bacterial Agents;
Child*;
Doxycycline*;
Fever;
Humans;
Levofloxacin*;
Macrolides;
Mycoplasma pneumoniae*;
Mycoplasma*;
Pneumonia*;
Pneumonia, Mycoplasma*;
Retrospective Studies
- From:Journal of Korean Medical Science
2018;33(43):e268-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: We aimed to compare the therapeutic efficacy of prolonged macrolide (PMC), corticosteroids (CST), doxycycline (DXC), and levofloxacin (LFX) against macrolide-unresponsive Mycoplasma pneumoniae (MP) pneumonia in children and to evaluate the safety of the secondary treatment agents. METHODS: We retrospectively analyzed the data of patients with MP pneumonia hospitalized between January 2015 and April 2017. Macrolide-unresponsiveness was clinically defined with a persistent fever of ≥ 38.0°C at ≥ 72 hours after macrolide treatment. The cases were divided into four groups: PMC, CST, DXC, and LFX. We compared the time to defervescence (TTD) after secondary treatment and the TTD after initial macrolide treatment in each group with adjustment using propensity score-matching analysis. RESULTS: Among 1,165 cases of MP pneumonia, 190 (16.3%) were unresponsive to macrolides. The proportion of patients who achieved defervescence within 48 hours in CST, DXC, and LFX groups were 96.9% (31/33), 85.7% (12/14), and 83.3% (5/6), respectively. The TTD after initial macrolide treatment did not differ between PMC and CST groups (5.1 vs. 4.2 days, P = 0.085), PMC and DXC groups (4.9 vs. 5.7 days, P = 0.453), and PMC and LFX groups (4.4 vs. 5.0 days, P = 0.283). No side effects were observed in the CST, DXC, and LFX groups. CONCLUSION: The change to secondary treatment did not show better efficacy compared to PMC in children with macrolide-unresponsive MP pneumonia. Further studies are needed to guide appropriate treatment in children with MP pneumonia.
