Mulholland Selamawit, Gavranich John B, Gillies Malcolm B, Chang Anne B
Queensland Respiratory Centre, Royal Children's Hospital, Herston Road, Herston, Brisbane, Queensland, Australia.
Cochrane Database Syst Rev. 2012 Sep 12(9):CD004875. doi: 10.1002/14651858.CD004875.pub4.
Mycoplasma pneumoniae (M. pneumoniae) is widely recognised as an important cause of community-acquired lower respiratory tract infection (LRTI) in children. Pulmonary manifestations are typically tracheobronchitis or pneumonia but M. pneumoniae is also implicated in wheezing episodes in both asthmatic and non-asthmatic individuals. Although antibiotics are used to treat LRTIs, a review of several major textbooks offers conflicting advice for using antibiotics in the management of M. pneumoniae LRTI in children.
To determine whether antibiotics are effective in the treatment of childhood LRTI secondary to M. pneumoniae infections acquired in the community.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to February week 5, 2012) and EMBASE (1980 to March 2012).
Randomised controlled trials (RCTs) comparing antibiotics commonly used for treating M. pneumoniae (i.e. macrolide, tetracycline or quinolone classes) versus placebo, or antibiotics from any other class in the treatment of children under 18 years of age with community-acquired LRTI secondary to M. pneumoniae.
The review authors independently selected trials for inclusion and assessed methodological quality. We extracted and analysed relevant data separately. We resolved disagreements by consensus.
A total of 1912 children were enrolled from seven studies. Data interpretation was limited by the inability to extract data that referred to children with M. pneumoniae. In most studies, clinical response did not differ between children randomised to a macrolide antibiotic and children randomised to a non-macrolide antibiotic. In one controlled study (of children with recurrent respiratory infections, whose acute LRTI was associated with Mycoplasma, Chlamydia or both by polymerase chain reaction, and/or paired sera) 100% of children treated with azithromycin had clinical resolution of their illness compared to 77% not treated with azithromycin at one month.
AUTHORS' CONCLUSIONS: There is insufficient evidence to draw any specific conclusions about the efficacy of antibiotics for this condition in children (although one trial suggests macrolides may be efficacious in some children with LRTI secondary to Mycoplasma). The use of antibiotics has to be balanced with possible adverse events. There is still a need for high quality, double-blinded RCTs to assess the efficacy and safety of antibiotics for LRTI secondary to M. pneumoniae in children.
肺炎支原体被广泛认为是儿童社区获得性下呼吸道感染（LRTI）的重要病因。肺部表现通常为气管支气管炎或肺炎，但肺炎支原体也与哮喘和非哮喘个体的喘息发作有关。尽管抗生素用于治疗下呼吸道感染，但查阅几本主要教科书发现，关于在儿童肺炎支原体LRTI治疗中使用抗生素的建议相互矛盾。
确定抗生素对社区获得性肺炎支原体感染继发的儿童LRTI治疗是否有效。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2012年第2期），其中包含Cochrane急性呼吸道感染小组的专业注册库、MEDLINE（1966年至2012年2月第5周）和EMBASE（1980年至2012年3月）。
比较常用的治疗肺炎支原体的抗生素（即大环内酯类、四环素类或喹诺酮类）与安慰剂，或任何其他类别的抗生素，用于治疗18岁以下社区获得性肺炎支原体继发LRTI儿童的随机对照试验（RCT）。
综述作者独立选择纳入试验并评估方法学质量。我们分别提取和分析相关数据。我们通过协商一致解决分歧。
七项研究共纳入1912名儿童。由于无法提取涉及肺炎支原体儿童的数据，数据解释受到限制。在大多数研究中，随机接受大环内酯类抗生素治疗的儿童与随机接受非大环内酯类抗生素治疗的儿童临床反应无差异。在一项对照研究中（针对反复呼吸道感染儿童，其急性LRTI通过聚合酶链反应和/或配对血清与支原体、衣原体或两者相关），与未接受阿奇霉素治疗的儿童相比，接受阿奇霉素治疗的儿童在1个月时100%临床症状缓解，而未接受治疗的儿童为77%。
没有足够证据就抗生素对这种情况下儿童的疗效得出任何具体结论（尽管一项试验表明大环内酯类可能对一些肺炎支原体继发LRTI儿童有效）。抗生素的使用必须与可能的不良事件相权衡。仍需要高质量的双盲RCT来评估抗生素对儿童肺炎支原体继发LRTI的疗效和安全性。
