Humans ; Pneumonia, Mycoplasma/drug therapy* ; Mycoplasma pneumoniae/isolation & purification* ; Child ; Anti-Bacterial Agents/therapeutic use* ; Evidence-Based Medicine ; China

OBJECTIVES: To investigate the efficacy and safety of prolonged azithromycin (PAZM) versus switching to doxycycline (SDXC) in the treatment of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children. METHODS: A total of 173 children with MUMPP who were hospitalized in Baoji Central Hospital, from January to December 2023 were selected as subjects. According to the choice of secondary antibiotic after 72 hours of initial macrolide therapy, they were divided into two groups: PAZM and SDXC. The efficacy and adverse drug reactions were compared between the two groups, and the risk factors for refractory Mycoplasma pneumoniae pneumonia (RMPP) were analyzed. RESULTS: Compared with the PAZM group, the SDXC group had significantly shorter time to defervescence and time to cough relief, a significantly lower proportion of patients using glucocorticoids, and a significantly higher proportion of patients with lung lesion absorption (P<0.05). No adverse reactions such as liver and kidney function impairment and tooth discoloration were observed in either group. RMPP occurred in 47 cases in the PAZM group. The univariate analysis showed that lactate dehydrogenase levels and age were risk factors for RMPP (P<0.05). CONCLUSIONS The efficacy of SDXC is superior to that of PAZM in children with MUMPP, and short-term use of doxycycline is relatively safe.
Humans ; Pneumonia, Mycoplasma/drug therapy* ; Doxycycline/administration & dosage* ; Female ; Male ; Azithromycin/administration & dosage* ; Child ; Child, Preschool ; Anti-Bacterial Agents/administration & dosage* ; Macrolides/administration & dosage* ; Adolescent ; Mycoplasma pneumoniae/drug effects*

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*

Macrolide and corticosteroid resistance has been reported in patients with Mycoplasma pneumoniae (MP) pneumonia (MPP). MP clearance is difficult to achieve through antibiotic treatment in sensitive patients with severe MPP (SMPP). SMPP in children might progress to airway remodeling and even bronchiolitis/bronchitis obliterans. Therefore, identifying serum biomarkers that indicate MPP progression and exploring new targeted drugs for SMPP treatment require urgency. In this study, serum samples were collected from patients with general MPP (GMPP) and SMPP to conduct proteomics profiling. The Fc fragment of the IgG-binding protein (FCGBP) was identified as the most promising indicator of SMPP. Biological enrichment analysis indicated uncontrolled inflammation in SMPP. ELISA results proved that the FCGBP level in patients with SMPP was substantially higher than that in patients with GMPP. Furthermore, the FCGBP levels showed a decreasing trend in patients with GMPP but the opposite trend in patients with SMPP during disease progression. Connectivity map analyses identified 25 possible targeted drugs for SMPP treatment. Among them, a mechanistic target of rapamycin kinase (mTOR) inhibitor, which is a macrolide compound and a cell proliferation inhibitor, was the most promising candidate for targeting SMPP. To our knowledge, this study was the first proteomics-based characterization of patients with SMPP and GMPP.
Biomarkers ; Carrier Proteins ; Child ; Humans ; Immunoglobulin Fc Fragments ; Immunoglobulin G ; Macrolides ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma/drug therapy* ; Proteomics

OBJECTIVE: To study the drug resistance of METHODS: BALF specimens were collected from 245 children with RMPP who were admitted to the Children's Hospital Affiliated to Zhengzhou University from March 2016 to December 2020. A rapid cultured drug sensitivity assay was used to detect the resistance of MP isolates to nine commonly used antimicrobial drugs. The real-time PCR was used to measure MP DNA. The direct sequencing was used to detect gene mutations in MP 23SrRNA V region central ring. RESULTS: Among the 245 BALF specimens, 207 tested positive for MP DNA, with a positive rate of 84.5%. The results of drug susceptibility test showed that the children with RMPP had a resistance rate of > 70% to macrolide antimicrobial drugs, with the highest resistance rate to clarithromycin, followed by roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin, and these children had a resistance rate of < 5% to quinolone antimicrobial drugs. Among the 207 MP DNA-positive specimens, 41 (19.8%) had no drug-resistance gene mutations and 166 (80.2%) had drug-resistance gene mutations, among which 154 (74.4%) had an A→G mutation at 2063 locus of 23SrRNA V region central ring, 7 (3.4%) had an A→G mutation at 2064 locus, and 5 (2.4%) had mutations in both 2063 and 2064 loci. Among the 166 specimens with point mutations of the MP 23SrRNA gene, 159 (95.8%) had point mutations at 2063 locus. The A→G point mutation at 2063 locus of 23SrRNA V region central ring had a great impact on resistance to macrolide antimicrobial drugs. There was a significant difference in the distribution of alleles at 2063 locus between the children with resistance to clarithromycin, roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin ( CONCLUSIONS MP in the BALF of children with RMPP has a relatively high resistance rate to macrolide antimicrobial drugs. Resistance to macrolide antimicrobial drugs is closely associated with the A→G point mutation in the 23SrRNA gene, and the point mutation at 2063 locus of 23SrRNA V region central ring may affect the drug-resistance mechanism of MP.
Anti-Bacterial Agents/pharmacology* ; Bronchoalveolar Lavage Fluid ; Child ; Drug Resistance, Bacterial/genetics* ; Humans ; Mycoplasma pneumoniae/genetics* ; Pneumonia, Mycoplasma/drug therapy*

To systematically evaluate the clinical efficacy of 14 oral Chinese patent medicines combined with Azithromycin in the treatment of mycoplasma pneumonia in children with network Meta-analysis. Computer retrieval was performed for such databases as CNKI, VIP, Wanfang, CBM, PubMed, EMbase and Cochrane Library to screen out randomized controlled trials of oral Chinese patent medicines combined with Azithromycin in the treatment of mycoplasma pneumonia in children from the time of database establishment to September 2020. The included studies were evaluated by the Cochrane Risk Assessment tool. Stata 14.0 and Review Manager 5.3 software were used for data statistical analysis. A total of 60 RCTs were included in this study, involving 14 oral Chinese patent medicines. The efficacy ranking based on network Meta-analysis was as follows:(1)in terms of total effective rate, top five Chinese patent medicines in surface under the cumulative ranking curve(SUCRA) were Xiao'er Xiaoji Zhike Oral Liquid, Xiao'er Chiqiao Qingre Granules, Xiao'er Feike Granules, Pudilan Xiaoyan Oral Liquid and Lanqin Oral Liquid;(2)in terms of antifebrile time, top five Chinese patent medicines in SUCRA were Huaiqihuang Granules, Xiao'er Magan Granules, Xiao'er Kechuanling Granules/Oral Liquid, Shuanghuang-lian Oral Liquid for children and Xiao'er Xiaoji Zhike Oral Liquid;(3)in terms of cough disappearance time, top five Chinese patent medicines in SUCRA were Xiao'er Magan Granules, Huaiqihuang Granules, Xiao'er Chiqiao Qingre Granules, Xiao'er Feire Kechuan Oral Liquid and Xiao'er Kechuanling Granules/Oral Liquid;(4)in terms of rale disappearance time, top five Chinese patent medicines in SUCRA were Xiao'er Magan Granules, Huaiqihuang Granules, Xiao'er Feire Kechuan Oral Liquid, Shuanghuanglian Oral Liquid for children and Yupingfeng Granules. The results showed that on the basis of the use of Azithromycin, combined administration with oral Chinese patent medicines could improve the overall clinical efficacy in the treatment of mycoplasma pneumonia in children. However, due to the large differences in the quality and the number of included studies among various therapeutic measures, the ranking results of SUCRA of Chinese patent medicines need to be verified by high-quality multi-center, large-sample, randomized double-blind trials in the future.
Azithromycin ; Child ; China ; Drugs, Chinese Herbal ; Humans ; Network Meta-Analysis ; Nonprescription Drugs ; Pneumonia, Mycoplasma/drug therapy* ; Randomized Controlled Trials as Topic

To assess the clinical efficacy of traditional Chinese medicine injection for adjuvant treatment of mycoplasma pneumoniae pneumonia in children by network Meta-analysis method. We retrieved CNKI, WanFang, CBM, Cochrane Library, PubMed from the establishment to September 2018. Two reviewers independently screened out literatures, extracted data and assessed the methodological quality of included studies. The data were analyzed by Stata 13.0 software. Totally 89 RCTs were included, involving 8 kinds of traditional Chinese medical injections and 8 936 patients. According to the results of network Meta-analysis, the order by the total effective rate from high to low was Huangqi Injection>Xiyanping Injection>Tanreqing Injection>Compound Danshen Injection>Reduning Injection>Yanhuning Injection>Qingkailing Injection>Xixinnao Injection; the order by cooling time from high to low was Reduning Injection> Yanhuning Injection>Qingkailing Injection>Tanreqing Injection>Huangqi Injection>Xiyanping Injection>Xiexinnao Injection>Compound Danshen Injection; the order by the cough disappeared time from high to low was Compound Danshen Injection>Qingkailing Injection>Xiyanping Injection>Huangqi Injection>Yanhuning Injection>Reduning Injection>Tanreqing Injection>Xixinnao Injection; the order by the rales disappearing time from high to low was Qingkailing Injection>Yanhuning Injection>Reduning Injection>Huangqi Injection>Tanreqing Injection>Xiyanping Injection>Xixinnao Injection. The results show that traditional Chinese medicine injection has a significant clinical efficacy in the adjuvant treatment of various symptoms of mycoplasma pneumoniae pneumonia in children. Due to the small sample size, more studies are required to verify the strength of evidence.
Child ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Injections ; Medicine, Chinese Traditional ; Network Meta-Analysis ; Pneumonia, Mycoplasma/drug therapy*

OBJECTIVETo observe the effects of Huaiqihuang granules on the immune function in children with severe Mycoplasma pneumoniae pneumonia.

METHODSPediatric inpatients with severe Mycoplasma pneumoniae pneumonia were randomly divided into Huaiqihuang granule treatment group (n=51) and conventional treatment group (n=47). The Huaiqihuang granule treatment group was orally administered Huaiqihuang granules in addition to the conventional treatment, while the conventional treatment group received conventional treatment only. Levels of serum IgA, IgG, and IgM, percentages of CD4and CD8 T lymphocyte subsets, and CD4/CD8ratio were examined in the two groups. The incidence rate of respiratory tract re-infection within three months following treatment was compared between the two groups.

RESULTSThe levels of serum IgA, IgG, and IgM, the percentage of CD4 T lymphocytes, and the CD4/CD8ratio were significantly higher in the Huaiqihuang granule treatment group than in the conventional treatment group three months after treatment (P<0.05). In contrast, the percentage of CD8T lymphocytes was significantly lower in the Huaiqihuang granule treatment group than in the conventional treatment group (P<0.05). In addition, the incidence rate of respiratory tract re-infection within three months following treatment was significantly lower in the Huaiqihuang granule treatment group than in the conventional treatment group (P<0.05).

CONCLUSIONSHuaiqihuang granules can regulate immune functions and reduce the incidence of short-term respiratory tract re-infection in children with severe Mycoplasma pneumoniae pneumonia.

Adolescent ; CD4-CD8 Ratio ; Child ; Child, Preschool ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Immunoglobulins ; analysis ; Male ; Pneumonia, Mycoplasma ; drug therapy ; immunology ; T-Lymphocyte Subsets ; drug effects ; immunology

OBJECTIVETo investigate the association of drug resistance of Mycoplasma pneumoniae (MP) with DNA load and genotypes in children with MP pneumonia.

METHODSA total of 230 children who were hospitalized and diagnosed with MP pneumonia between January 2012 and December 2016 were enrolled. Throat swabs were collected from the 230 children, and a rapid drug sensitivity assay was used to determine the sensitivity of clinical isolates of MP to nine commonly used antibacterial agents. Quantitative real-time PCR was used to measure MP-DNA load in throat swabs. PCR sequencing was used to determine the genotype of 2063 locus of the MP 23S rRNA V domain.

RESULTSOf the 230 children, 86 (37.4%) had genotype A in 2063 locus, 134 (58.3%) had genotype G, 8 (3.5%) had genotype C, and 2 (0.9%) had genotype T. Mutant strains (genotype G+C+T) had a significantly higher MP-DNA load than wild-type strains (genotype A) (P<0.05). The strains resistant to erythromycin, azithromycin, clarithromycin, and clindamycin had a significantly higher MP-DNA load than non-resistant strains (P<0.05). MP had a high drug resistance rate to macrolide antibiotics. More than 60% of the cases with resistance to macrolides were found to have A2063G mutations. MP was rarely resistant to quinolones (less than 2%).

CONCLUSIONSMutations in 2063 locus of the MP 23S rRNA V domain may result in the resistance of MP to macrolides and the change in DNA load and can be used as a basis for selecting drugs for MP.

Child ; Child, Preschool ; DNA, Bacterial ; analysis ; Drug Resistance, Bacterial ; Female ; Genotype ; Humans ; Infant ; Male ; Mycoplasma pneumoniae ; drug effects ; genetics ; Pneumonia, Mycoplasma ; drug therapy ; microbiology

OBJECTIVETo explore the effect of Qingfei Huoxue Recipe (QHR) combined azithromycin in treatment of intractable pediatric mycoplasma pneumonia.

METHODSTotally 124 intractable pediatric mycoplasma pneumonia patients at our hospital were recruited in this study, and randomly assigned to the treatment group and the control group, 62 in each group. Patients in the control group took azithromycin, while those in the treatment group additionally took QHR. All patients received omnibearing systematic nursing. Therapeutic efficacy, clinical indices (such as disappearance time of cough and rales, recovery time of body temperature) , and the incidence of adverse reactions were observed.

RESULTSAfter treatment the total effective rate was 91.94% (57/62 cases) in the treatment group and 77. 42% (48/62 cases) in the control group with statistical difference (P < 0.05). Compared with the control group, disappearance time of cough and rales, recovery time of body temperature were obviously shortened in the treatment group with statistical difference (P < 0.01). There was statistical difference in the incidence of adverse reactions between the two groups [3.23% (2/62 cases) vs 38.71% (24/62 cases) , P < 0.01].

CONCLUSIONIn clinical treatment for intractable pediatric mycoplasma pneumonia, Chinese medicine combined Western medicine plus scientific and systematic nursing showed more obvious advantages with significant efficacy, which was worth spreading.

Azithromycin ; Biomedical Research ; Child ; Cough ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, East Asian Traditional ; Phytotherapy ; Pneumonia, Mycoplasma ; drug therapy