Child ; Humans ; Pneumonia, Mycoplasma/epidemiology* ; Macrolides/therapeutic use* ; Singapore/epidemiology* ; Child, Hospitalized ; Mycoplasma pneumoniae ; Anti-Bacterial Agents/therapeutic use* ; Drug Resistance, Bacterial ; Community-Acquired Infections/drug therapy*

OBJECTIVETo evaluate the therapeutic effects of antibacterial agents, glucocorticoid and intravenous immunoglobulin (IVIG) in treating Mycoplasma pneumoniae(MP) infections.

METHODThe literature was screened by the inclusion and exclusion criteria after searching at Cochrane Library, Pubmed, Wanfang, CNKI, and Weipu databases. According to JADAD evaluation system, the relevant information in each included report from the literature was evaluated. The evidence-based analysis was performed for the therapeutic effects of macrolides, glucocorticoid, and IVIG in treating MP infections. Meta-analysis was conducted on the suitable literature by RevMan 5.3 software supplied by Cochrane collaboration. Descriptive analysis was conducted on the literature unsuitable for meta-analysis.

RESULT(1) Seven foreign RCT reports and 7 domestic RCT reports were included in the analysis of the therapeutic effect of macrolides. There was a high heterogeneity among the 7 foreign reports. Five of these reports showed no significant difference in clinical effects between macrolides and non-macrolide antibacterial agents. The forest plot analysis of antipyretic timing and cough duration in the domestic literature with complete indicators suggested that for azithromycin sequential therapy vs. erythromycin intravenous therapy, the mean difference of antipyretic timing was-1.10 (95% CI: -1.60,-0.60) and the mean difference of cough duration was-1.56 (95% CI: -2.10,-1.03). (2) Three foreign RCT reports and 5 domestic RCT were included in the analysis of glucocorticoid therapy. The JADAD scores of all the reports were 1. The basic therapy drug was macrolides. The results of sub-group analysis suggested that for the patients who used glucocorticoid early vs. the patients who used non-glucocorticoid therapy, the mean difference of antipyretic time was-1.77(95% CI: -2.44,-1.10) and the mean difference of cough duration was-2.47 (95% CI: -2.86,-2.08); for the patients treated with glucocorticoid at 10 days after onset of diseases vs. the patients received non-glucocorticoid therapy, the mean difference of antipyretic time was-3.41 (95% CI: -4.10,-2.73) and the mean difference of cough duration was-2.25 (95%CI: -4.38,-0.12). (3) Regarding IVIG, all the included reports were case study or case report. Most of the literature focused on severe Mycoplasma pneumoniae infection and those with extrapulmonary complications. The limited results suggested a trend of the shortening of disease process and improvement of clinical symptoms by IVIG.

CONCLUSIONThere was no exact evidence of the therapeutic effects of antibacterial agents in Mycoplasma pneumoniae infections. A trend of better therapeutic effect was inferred in macrolide antibiotics, especially azithromycin. The improvement of clinical symptoms was suggested with the usage of glucocorticoid as adjuvant therapy. IVIG as an adjuvant therapy is at an exploration stage.

Anti-Bacterial Agents ; therapeutic use ; Azithromycin ; therapeutic use ; Child ; Cough ; Erythromycin ; therapeutic use ; Glucocorticoids ; therapeutic use ; Humans ; Immunoglobulins, Intravenous ; therapeutic use ; Macrolides ; therapeutic use ; Mycoplasma Infections ; drug therapy ; Mycoplasma pneumoniae ; Randomized Controlled Trials as Topic

Diffuse panbronchiolitis (DPB) is a bronchiolitis affecting the whole lung fields which can be treated by macrolide. Especially East Asian patients are more susceptible to diffuse panbronchiolitis. As asthma and DPB both can cause airway obstruction, differential diagnosis is important for the 2 diseases. Here we report 5 patients with DPB clinically presenting as severe asthma in Korea, who were well treated by macrolide. Among the 5 patients, 2 could stop their asthma inhalers and the other 3 could reduce asthma medications after diagnosis and treatment of DPB. In conclusion, considering DPB as differential diagnosis for asthmatics in Asian ethnic groups is important.
Adult ; Aged ; Anti-Asthmatic Agents/*therapeutic use ; Asthma/*diagnosis/*drug therapy ; Bronchiolitis/*diagnosis/*drug therapy ; Diagnosis, Differential ; Female ; Haemophilus Infections/*diagnosis/*drug therapy ; Humans ; Macrolides/*administration & dosage ; Male ; Middle Aged ; Severity of Illness Index ; Treatment Outcome

BACKGROUNDMycoplasma pneumonia (M. pneumoniae) is one of the key pathogens of community-acquired pneumonia. A global pandemic of M. pneumoniae has occurred since 2010. The aim of this study was to survey the prevalence of M. pneumoniae in children in Beijing from 2007-2012.

METHODSA total of 3 073 clinical specimens were obtained from pediatric patients with respiratory tract infections from January 2007 to December 2012, and examined by nested polymerase chain reaction. PCR products were visualized by 2% agarose gel electrophoresis, positive products sequenced, and compared with reference sequences in GenBank. Macrolide resistance-associated mutations were also detected for some positive samples.

RESULTSOf the 3 073 specimens, 588 (19.13%) were positive for M. pneumoniae, 12.4% of which were accompanied by viral infections. Positive rates for M. pneumoniae were highest in 2007 and 2012, showing a significant difference when compared with other years. Infections tended to occur in autumn and winter and positive rates were significantly higher for children aged 3-16. The rate of macrolide resistance-associated mutations was 90.7%, and the predominant mutation was an A→G transition (89.92%) at position 2063 in domain V of the 23S rRNA gene.

CONCLUSIONSM. pneumoniae outbreaks occurred in 2007 and 2012 in pediatric patients in Beijing, which is consistent with the global prevalence of M. pneumoniae. M. pneumoniae can cause multi-system infections in children, and may be accompanied with viral infections. We determined that school-age children are more susceptible to this disease, particularly in autumn and winter. Gene mutations associated with macrolide resistance were very common in M. pneumoniae-positive specimens during this period in Beijing.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Humans ; Macrolides ; therapeutic use ; Male ; Mycoplasma pneumoniae ; pathogenicity ; Pneumonia, Mycoplasma ; drug therapy ; epidemiology ; Prevalence

OBJECTIVETo analyze the clinical characteristics of Mycoplasma pneumoniae-associated hemophagocytic syndrome (MP-HLH).

METHODA retrospective investigation of the clinical manifestation, laboratory test, imagelogy, clinical course and outcome of 3 cases with MP-HLH seen between June 2013 and July 2013 in Shenzhen Children's Hospital, and review of relevant literature were conducted.

RESULTOf the 3 cases of MP-HLH, 2 were males, one was female, the ages were 1 year, 3 years and 6 years, respectively. They had no underlying disease previously. All the 3 cases had onset of fever, cough as main symptoms. Diagnosis of refractory Mycoplasma pneumoniae pneumonia was made, which was accompanied by decreased neutrophils [(0.08-0.68)×10(9)/L], hemoglobin [(79-103) g/L], platelet [(64-157)×10(9)/L], plasma fibrinogen [(1.3-1.5) g/L], lactate dehydrogenase [(1,170-1,285) U/L] and increased serum ferritin [(936.7-39 789.0) µg/L] in the third week of course. In two cases the T lymphocytes decreased, and the NK cell activity decreased significantly in one. Bone marrow cytology showed prompted bone marrow hyperplasia, and the phenomenon of phagocytosed blood cells. CT scan was performed for all the cases and consolidation with pleural effusion were shown. Two cases were admitted to PICU, and required endotracheal intubation and mechanical ventilation. Flexible bronchoscopy and bronchial lavage were performed and bronchial cast was found in two cases. All of them were treated with macrolide combined with other antibiotics, glucocorticoids and gamma globulin combination therapy, including one case given dexamethasone [10 mg/(m2·d)], cyclosporine[6 mg/(kg·d)], etoposide [150 mg/(m2·d)] chemotherapy. Two cases were cured, and 1 case died. The authors summarized the 18 cases reported in domestic and foreign literature. Foreign children were diagnosed and treated with steroids in 1-2 weeks, and 10 cases were cured, and 2 cases died. They died of massive hemorrhage and meningoencephalitis, and domestic children were diagnosed and treated within two to 4 weeks after onset, 5 cases were cured, one case died of severe pneumonia.

CONCLUSIONMP-HLH is a rare disease in children, and had acute onset, rapid progression and high mortality. Early treatment with steroids was associated with a good prognosis, the key to successful treatment is early diagnosis and treatment, avoiding the immune cascade. Too late a diagnosis or development of serious complications may lead to death.

Anti-Bacterial Agents ; therapeutic use ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Child ; Child, Preschool ; Fatal Outcome ; Female ; Fever ; Glucocorticoids ; therapeutic use ; Humans ; Infant ; Lymphohistiocytosis, Hemophagocytic ; diagnosis ; drug therapy ; microbiology ; Macrolides ; therapeutic use ; Male ; Mycoplasma pneumoniae ; isolation & purification ; Pleural Effusion ; Pneumonia, Mycoplasma ; complications ; diagnosis ; drug therapy ; Respiration, Artificial ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVE: Invastigation of macrolides in the treatment of drug effects in chronic rhinosinusit. METHOD: The 165 patients with chronic rhinosinusit were randomly divided into 80 cases of macrolides drug group and 85 cases of cephalosporins group, and therapeutic effect was observed. The therapeutic effect of macrolides was also observed in refractory chronic rhinosinusit. RESULT: Comparing macrolides group and cephalosporins group,there is not statistically significant (P > 0.05). Treatment with macrolides cefixime tablet ineffective treatment of patients for 3 months, compared before and after treatment was statistically significant (P < 0.01). Treatment with cefixime tablet macrolides ineffective treatment of patients for 3 months, compared before and after treatment was not statistically significant (P > 0.05). CONCLUSION Long-term low-dose applications of macrolides have a good effect in patients with chronic rhinosinusit, particularly for refractory chronic rhinosinusit have a significant effect.
Anti-Bacterial Agents ; therapeutic use ; Cephalosporins ; therapeutic use ; Chronic Disease ; Humans ; Macrolides ; therapeutic use ; Rhinitis ; drug therapy ; Sinusitis ; drug therapy ; Treatment Outcome

OBJECTIVE: To evaluate the efficacy of standardized medication for patients with chronic rhinosinusitis. METHOD: According to the diagnosis and treatment guidelines on chronic rhinosinusitis formulated in 2008, by means of prospective study, we studied 54 patients suffering from chronic rhinosinusitis treated with standardized medication including, a combination of local intranasaI corticosteroids, macrolides, mucus discharging agent and nasal irrigation treatment and followed up for 3 months. Visual analogue scale (VAS), sino nasal outcome test-20 Chinese version scales (SNOT-20 CV), Lund-Mackay CT and Lund-Kennedy endoscopy methods were employed to conduct the subjective and objective assessment and comprehensively evaluate the clinical efficacy before and after treatment. RESULT: (1) After three months of standardized medication, the patients' total scores of VAS, SNOT-20 CV, CT and endoscopy were improved significantly compared with those before-treatment (P < 0.01 for all these scoring systems). (2) There was statistically significant difference between the clinical efficacies of chronic rhinosinusitis patients with and without nasal polyps groups (P < 0.01). After 3 months of standardized medication, the effective rates of the CRSwNP group evaluated by subjective assessment and CT evaluation were 66.7% and 94.4% respectively, while those of the CRSsNP groups were 91.7% and 97.2% respectively. (3) Betwecn CRSwNP and CRSsNP groups, there was no significant difference in the improvement rate or inefficiency rate in subjective assessment except for the cure rate, while there were significant differences in both cure rate and improvement rate in CT evaluation. (4) The CRS patients' self-testing-based questionnaires results showed positive correlation with objective assessments. CONCLUSION The standardized medication with combination of intranasal local glucocorticoid, macrolides (14-membered ring), the mucus discharging agent and nasal irrigation on CRS was effective.
Administration, Intranasal ; Adult ; Aged ; Chronic Disease ; Female ; Glucocorticoids ; administration & dosage ; therapeutic use ; Humans ; Macrolides ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Rhinitis ; drug therapy ; Sinusitis ; drug therapy ; Treatment Outcome ; Young Adult

OBJECTIVETo analyze clinical manifestations, treatment and prognosis of 4 cases with endemic typhus.

METHODThe clinical data of four endemic typhus patients in prognosis were retrospectively analyzed. These four atypical cases of endemic typhus with pneumonia were treated in our department from October 2011 to March 2012. They were all male, with an age range of 15 months to 7 years. The four patients had long history, mild respiratory symptom and no improvement was found after treatment with cephalosporins. There were no evidences of bacterial, viral, or fungal infections and we thought they might have infection with other pathogen. Three were from rural areas. Routine blood tests, Weil-Felix reaction, blood smear (Giemsa staining) , and indirect immunofluorescence assay were performed.

RESULTBlood smear and IFA tests showed evidences for endemic typhus. The clinical presentations were atypical, the patients had no headache, but all had fever, rash, and pneumonia of varying severity. None of the patients had a severe cough, but bronchial casts were observed in one case. Recurrent fever was reported in three cases. Physical examinations showed no eschars, but one patient had a subconjunctival hemorrhage, and one had skin scratches, cervical lymphadenopathy, pleural effusion, pericardial effusion, and cardiac dilatation. Two patients had remarkably increased peripheral blood leukocyte counts; both these patients also had high alanine aminotransferase (ALT) levels and one had a high C-reactive protein (CRP) level. Weil-Felix testing was negative or the OX19 titer was low. The peripheral blood smear (Giemsa stain) showed intracellular pathogens in all four cases. After combined therapy with doxycycline and macrolide antibiotics, all four patients recovered well.

CONCLUSIONThe endemic typhus children often come from rural areas. The clinical presentations were atypical, they usually have no headache, but have fever (often Periodic fever) , rash, and pneumonia of varying severity in these four cases. Combined therapy with doxycycline and macrolide antibiotics was effective in all four patients.

Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Doxycycline ; therapeutic use ; Fever ; diagnosis ; drug therapy ; pathology ; Fluorescent Antibody Technique, Indirect ; Humans ; Infant ; Leukocyte Count ; Lung ; diagnostic imaging ; pathology ; Macrolides ; therapeutic use ; Male ; Pneumonia ; diagnosis ; drug therapy ; pathology ; Radiography ; Retrospective Studies ; Staining and Labeling ; methods ; Typhus, Endemic Flea-Borne ; diagnosis ; drug therapy ; pathology

Dental surgery is very common, and it is important for our dental colleagues to understand the medical history and chronic medications of our co-managed patients. Antibiotic prophylaxis is currently recommended only for patients at high risk for infective endocarditis when undergoing high-risk dental procedures. Good dental hygiene can prevent more infective endocarditis than prophylactic antibiotic therapy, as transient bacteraemia is common in daily activities such as the brushing and flossing of teeth. Most dental surgeries can generally be performed on patients taking a daily dose of aspirin, but the dentist must be able to assess the risk-benefit ratio of employing local measures of haemostasis versus stopping the antiplatelet therapy. Patients on antiplatelet with recent coronary artery stenting should be referred to their primary cardiologist regarding the cessation of these agents before any surgery.
Angioplasty ; Antibiotic Prophylaxis ; methods ; Aspirin ; therapeutic use ; Dental Care for Chronically Ill ; methods ; Dentists ; Drug Interactions ; Endocarditis ; prevention & control ; Humans ; Hyperlipidemias ; complications ; Macrolides ; adverse effects ; Male ; Mitral Valve Prolapse ; complications ; Myocardial Ischemia ; complications ; Platelet Aggregation Inhibitors ; adverse effects ; Simvastatin ; adverse effects ; Streptococcal Infections ; prevention & control ; Tooth Extraction ; methods ; Viridans Streptococci ; metabolism

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Chronic Disease ; Humans ; Macrolides ; administration & dosage ; therapeutic use ; Sinusitis ; drug therapy