Department of Pediatrics, Gachon University College of Medicine, Incheon, Korea.
Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea.
J Korean Med Sci. 2018 Sep 18;33(43):e268. doi: 10.3346/jkms.2018.33.e268. eCollection 2018 Oct 22.
We aimed to compare the therapeutic efficacy of prolonged macrolide (PMC), corticosteroids (CST), doxycycline (DXC), and levofloxacin (LFX) against macrolide-unresponsive (MP) pneumonia in children and to evaluate the safety of the secondary treatment agents.
We retrospectively analyzed the data of patients with MP pneumonia hospitalized between January 2015 and April 2017. Macrolide-unresponsiveness was clinically defined with a persistent fever of ≥ 38.0°C at ≥ 72 hours after macrolide treatment. The cases were divided into four groups: PMC, CST, DXC, and LFX. We compared the time to defervescence (TTD) after secondary treatment and the TTD after initial macrolide treatment in each group with adjustment using propensity score-matching analysis.
Among 1,165 cases of MP pneumonia, 190 (16.3%) were unresponsive to macrolides. The proportion of patients who achieved defervescence within 48 hours in CST, DXC, and LFX groups were 96.9% (31/33), 85.7% (12/14), and 83.3% (5/6), respectively. The TTD after initial macrolide treatment did not differ between PMC and CST groups (5.1 vs. 4.2 days, = 0.085), PMC and DXC groups (4.9 vs. 5.7 days, = 0.453), and PMC and LFX groups (4.4 vs. 5.0 days, = 0.283). No side effects were observed in the CST, DXC, and LFX groups.
The change to secondary treatment did not show better efficacy compared to PMC in children with macrolide-unresponsive MP pneumonia. Further studies are needed to guide appropriate treatment in children with MP pneumonia.
我们旨在比较延长大环内酯类（PMC）、皮质类固醇（CST）、强力霉素（DXC）和左氧氟沙星（LFX）对儿童大环内酯类治疗无反应性（MP）肺炎的治疗效果，并评估二线治疗药物的安全性。
我们回顾性分析了 2015 年 1 月至 2017 年 4 月期间住院的 MP 肺炎患者的数据。大环内酯类无反应性根据大环内酯类治疗后≥72 小时持续发热≥38.0°C 临床定义。病例分为 PMC、CST、DXC 和 LFX 四组。我们比较了每组二线治疗后退热时间（TTD）和初始大环内酯类治疗后 TTD，并采用倾向评分匹配分析进行调整。
在 1165 例 MP 肺炎中，190 例（16.3%）对大环内酯类无反应。CST、DXC 和 LFX 组中，48 小时内退热的患者比例分别为 96.9%（31/33）、85.7%（12/14）和 83.3%（5/6）。PMC 和 CST 组（5.1 与 4.2 天， = 0.085）、PMC 和 DXC 组（4.9 与 5.7 天， = 0.453）、PMC 和 LFX 组（4.4 与 5.0 天， = 0.283）之间初始大环内酯类治疗后 TTD 无差异。CST、DXC 和 LFX 组未观察到不良反应。
与儿童大环内酯类治疗无反应性 MP 肺炎相比，二线治疗方案并未显示出优于 PMC 的疗效。需要进一步研究以指导儿童 MP 肺炎的适当治疗。
