多西环素治疗不同时期儿童大环内酯类耐药肺炎支原体肺炎的疗效。
Efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods.
机构信息
Pediatric Department, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China.
出版信息
Ital J Pediatr. 2024 Mar 5;50(1):38. doi: 10.1186/s13052-024-01615-y.
BACKGROUND
The prevalence of macrolide-resistant Mycoplasma pneumoniae has increased considerably. Treatment in children has become challenging. This study aimed to evaluate the efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods.
METHODS
We retrospectively analyzed the data of patients with macrolide-resistant Mycoplasma pneumoniae pneumonia hospitalized between May 2019 to August 2022. According to treatment, patients were divided into three groups: oral doxycycline treatment alone (DOX group), changed from intravenous azithromycin to oral doxycycline (ATD group), and intravenous azithromycin treatment alone (AZI group). ATD group cases were separated into two sub-groups: intravenous azithromycin treatment<3 days (ATD1 group) and ≥ 3 days (ATD2 group). Clinical symptoms were compared in each group and adjusted by Propensity score matching (PSM) analysis.
RESULTS
A total of 106 were recruited in this study. 17 (16%) were in DOX group, 58 (55%) in ATD group, and 31(29%) in AZI group. Compared with ATD group and AZI group, the DOX group showed shorter hospitalization duration and fever duration after treatment, while higher rate of chest radiographic improvement. After using PSM analysis, shorter days to hospitalization duration (P = 0.037) and to fever duration after treatment (P = 0.027) in DOX + ATD1 group than in ATD2 group was observed. A higher number of patients in the DOX + ATD1 group achieved defervescence within 72 h (P = 0.031), and fewer children received glucocorticoid adjuvant therapy (P = 0.002). No adverse reactions associated with doxycycline was observed during treatment.
CONCLUSIONS
Children receiving early oral doxycycline had a shorter duration of fever and hospitalization in macrolide-resistant Mycoplasma pneumoniae patients.
背景
大环内酯类耐药肺炎支原体的流行率显著增加，儿童的治疗变得极具挑战性。本研究旨在评估不同时期使用多西环素治疗儿童大环内酯类耐药肺炎支原体肺炎的疗效。
方法
我们回顾性分析了 2019 年 5 月至 2022 年 8 月期间住院的大环内酯类耐药肺炎支原体肺炎患者的数据。根据治疗方法，将患者分为三组：单独口服多西环素治疗组（DOX 组）、从静脉注射阿奇霉素改为口服多西环素组（ATD 组）和单独静脉注射阿奇霉素治疗组（AZI 组）。ATD 组患者再分为静脉注射阿奇霉素治疗<3 天（ATD1 组）和≥3 天（ATD2 组）亚组。比较各组的临床症状，并通过倾向评分匹配（PSM）分析进行调整。
结果
本研究共纳入 106 例患者，其中 17 例（16%）在 DOX 组，58 例（55%）在 ATD 组，31 例（29%）在 AZI 组。与 ATD 组和 AZI 组相比，DOX 组治疗后住院时间和发热时间更短，胸部影像学改善率更高。经 PSM 分析后，DOX+ATD1 组的住院时间（P=0.037）和治疗后发热时间（P=0.027）均短于 ATD2 组。DOX+ATD1 组有更多患者在 72 小时内退热（P=0.031），且接受糖皮质激素辅助治疗的患儿更少（P=0.002）。治疗期间未观察到与多西环素相关的不良反应。
结论
对于大环内酯类耐药肺炎支原体感染的患儿，早期口服多西环素可缩短发热时间和住院时间。
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