目的 比较儿童大环内酯类无反应性肺炎支原体肺炎（macrolide-unresponsive Mycoplasma pneumoniae pneumonia, MUMPP）延长阿奇霉素（prolonged azithromycin, PAZM）与换用多西环素（switching to doxycycline, SDXC）的疗效和安全性。 方法 选取2023年1—12月于宝鸡市中心医院住院的173例MUMPP患儿为研究对象，根据初始大环内酯类药物治疗72 h后二次抗生素的选择分为PAZM组和SDXC组，比较两组疗效、药物不良反应，分析难治性肺炎支原体肺炎（refractory Mycoplasma pneumoniae pneumonia, RMPP）的危险因素。 结果 SDXC组退热时间、咳嗽缓解时间、糖皮质激素使用率均短于或低于PAZM组（P<0.05），肺部病灶吸收率高于PAZM组（P<0.05）。两组均未发生肝肾功能损伤和牙齿变色等不良反应。PAZM组中有47例发生RMPP。单因素分析显示乳酸脱氢酶及年龄是RMPP的危险因素（P<0.05）。 结论 MUMPP患儿中SDXC组疗效优于PAZM组，多西环素短期使用相对安全。
Abstract
Objective 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.
关键词
难治性肺炎支原体肺炎 /
阿奇霉素 /
多西环素 /
儿童
Key words
Refractory Mycoplasma pneumoniae pneumonia /
Azithromycin /
Doxycycline /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Waites KB, Xiao L, Liu Y, et al. Mycoplasma pneumoniae from the respiratory tract and beyond[J]. Clin Microbiol Rev, 2017, 30(3): 747-809. PMID: 28539503. PMCID: PMC5475226. DOI: 10.1128/CMR.00114-16.
2 Matsuda K, Narita M, Sera N, et al. Gene and cytokine profile analysis of macrolide-resistant Mycoplasma pneumoniae infection in Fukuoka, Japan[J]. BMC Infect Dis, 2013, 13: 591. PMID: 24330612. PMCID: PMC3883477. DOI: 10.1186/1471-2334-13-591.
3 Tsai TA, Tsai CK, Kuo KC, et al. Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children[J]. J Microbiol Immunol Infect, 2021, 54(4): 557-565. PMID: 33268306. DOI: 10.1016/j.jmii.2020.10.002.
4 Yamazaki T, Kenri T. Epidemiology of Mycoplasma pneumoniae infections in Japan and therapeutic strategies for macrolide-resistant M. pneumoniae[J]. Front Microbiol, 2016, 7: 693. PMID: 27242718. PMCID: PMC4876131. DOI: 10.3389/fmicb.2016.00693.
5 Cardinale F, Chironna M, Chinellato I, et al. Clinical relevance of Mycoplasma pneumoniae macrolide resistance in children[J]. J Clin Microbiol, 2013, 51(2): 723-724. PMID: 23224091. PMCID: PMC3553869. DOI: 10.1128/JCM.02840-12.
6 赵顺英, 刘瀚旻, 陆权, 等. 儿童肺炎支原体肺炎诊治的专家释疑（2023年11月）[J]. 中华儿科杂志, 2024, 62(2): 108-113. PMID: 38228509. DOI: 10.3760/cma.j.cn112140-20231120-00382.
7 Hubert D, Dumke R, Weichert S, et al. Emergence of macrolide-resistant Mycoplasma pneumoniae during an outbreak in a primary school: clinical characterization of hospitalized children[J]. Pathogens, 2021, 10(3): 328. PMID: 33802078. PMCID: PMC7999249. DOI: 10.3390/pathogens10030328.
8 中华人民共和国国家卫生健康委员会. 儿童肺炎支原体肺炎诊疗指南（2023年版）[J]. 国际流行病学传染病学杂志, 2023, 50(2): 79-85. DOI: 10.3760/cma.j.cn331340-20230217-00023.
9 曾兆彬, 王奇伟, 刘鼎立, 等. 不同剂量甲泼尼龙对小儿难治性肺炎支原体肺炎的疗效分析[J]. 中华全科医学, 2020, 18(7): 1150-1152, 1226. DOI: 10.16766/j.cnki.issn.1674-4152.001452.
10 Shah SS, Test M, Sheffler-Collins S, et al. Macrolide therapy and outcomes in a multicenter cohort of children hospitalized with Mycoplasma pneumoniae pneumonia[J]. J Hosp Med, 2012, 7(4): 311-317. PMID: 22271440. DOI: 10.1002/jhm.1904.
11 Ishiguro N, Koseki N, Kaiho M, et al. Therapeutic efficacy of azithromycin, clarithromycin, minocycline and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients[J]. PLoS One, 2017, 12(3): e0173635. PMID: 28288170. PMCID: PMC5348022. DOI: 10.1371/journal.pone.0173635.
12 Chen J, Qi X, Yin Y, et al. Effects of minocycline on macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a single-center retrospective study[J]. Transl Pediatr, 2021, 10(11): 2997-3004. PMID: 34976765. PMCID: PMC8649588. DOI: 10.21037/tp-21-356.
13 Kawai Y, Miyashita N, Kubo M, et al. Therapeutic efficacy of macrolides, minocycline, and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae pneumonia in pediatric patients[J]. Antimicrob Agents Chemother, 2013, 57(5): 2252-2258. PMID: 23459497. PMCID: PMC3632908. DOI: 10.1128/AAC.00048-13.
14 Tredwin CJ, Scully C, Bagan-Sebastian JV. Drug-induced disorders of teeth[J]. J Dent Res, 2005, 84(7): 596-602. PMID: 15972585. DOI: 10.1177/154405910508400703.
15 Chen Y, Zhang Y, Tang QN, et al. Efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods[J]. Ital J Pediatr, 2024, 50(1): 38. PMID: 38439015. PMCID: PMC10913651. DOI: 10.1186/s13052-024-01615-y.
16 P?yh?nen H, Nurmi M, Peltola V, et al. Dental staining after doxycycline use in children[J]. J Antimicrob Chemother, 2017, 72(10): 2887-2890. PMID: 29091225. PMCID: PMC5890778. DOI: 10.1093/jac/dkx245.
17 Xie Q, Zhang X, Cui W, et al. Construction of a nomogram for identifying refractory Mycoplasma pneumoniae pneumonia among macrolide-unresponsive mycoplasma pneumoniae pneumonia in children[J]. J Inflamm Res, 2022, 15: 6495-6504. PMID: 36474517. PMCID: PMC9719700. DOI: 10.2147/JIR.S387809.
18 郑雪香, 林继雷, 代继宏. 基于决策曲线和剂量反应分析评估乳酸脱氢酶对儿童难治性肺炎支原体肺炎的预测价值[J]. 中国当代儿科杂志, 2020, 22(2): 112-117. PMID: 32051076. PMCID: PMC7390016. DOI: 10.7499/j.issn.1008-8830.2020.02.006.
19 管峥, 霍洁, 袁晶, 等. 血清乳酸脱氢酶联合白细胞介素18对儿童难治性肺炎支原体肺炎的预测作用[J]. 实用医学杂志, 2020, 36(20): 2848-2851. DOI: 10.3969/j.issn.1006-5725.2020.20.021.
20 郭丽军. 小儿难治性肺炎支原体肺炎临床治疗分析[J]. 中国实用医药, 2011, 6(25): 68-69. DOI: 10.3969/j.issn.1673-7555.2011.25.046.
21 Ding G, Zhang X, Vinturache A, et al. Challenges in the treatment of pediatric Mycoplasma pneumoniae pneumonia[J]. Eur J Pediatr, 2024, 183(7): 3001-3011. PMID: 38634891. DOI: 10.1007/s00431-024-05519-1.
PDF(597 KB)
