School of Medicine, University of Western Australia, Crawley.
Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia.
J Pediatric Infect Dis Soc. 2018 Feb 19;7(1):71-77. doi: 10.1093/jpids/pix083.
Pneumonia, most often caused by a respiratory virus, is common in childhood. Mycoplasma pneumoniae also is detected frequently, particularly in older children in the era of pneumococcal conjugate vaccination. Despite recommendations for β-lactam antibiotics, macrolide antibiotics, including erythromycin, clarithromycin, and azithromycin, are prescribed frequently to children with acute lower respiratory infection. However, the significance of detecting "atypical" pathogens, including M pneumoniae, in children remains contentious. Considering the potential for antibacterial and anti-inflammatory activities of macrolides, our understanding of the role of these drugs in acute and chronic infections and in inflammatory conditions is changing. Some observational data have revealed improved outcomes in adults and children with pneumonia who are prescribed macrolides, although its widespread use has led to increases in macrolide resistance in Streptococcus pneumoniae and M pneumoniae. Clinical trials to define the role of macrolides in pediatric acute respiratory infection must be prioritized.
肺炎，多由呼吸道病毒引起，在儿童中很常见。在肺炎球菌结合疫苗时代，也经常检测到肺炎支原体，尤其是年龄较大的儿童。尽管建议使用β-内酰胺类抗生素，但仍经常为急性下呼吸道感染的儿童开具包括红霉素、克拉霉素和阿奇霉素在内的大环内酯类抗生素。然而，检测“非典型”病原体（包括肺炎支原体）在儿童中的意义仍存在争议。考虑到大环内酯类药物具有潜在的抗菌和抗炎活性，我们对这些药物在急性和慢性感染以及炎症性疾病中的作用的理解正在发生变化。一些观察性数据显示，肺炎和儿童肺炎患者使用大环内酯类药物可改善结局，尽管其广泛使用导致肺炎链球菌和肺炎支原体对大环内酯类药物的耐药性增加。必须优先进行临床试验以确定大环内酯类药物在儿科急性呼吸道感染中的作用。
