Bolormaa Erdenetuya, Park Ji Young, Choe Young June, Kang Cho Ryok, Choe Seung Ah, Mylonakis Eleftherios
From the Department of Preventive Medicine.
Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
Pediatr Infect Dis J. 2025 Mar 1;44(3):200-206. doi: 10.1097/INF.0000000000004568. Epub 2024 Oct 2.
The global prevalence of macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia infections, particularly in children, is on the rise. It is imperative to assess the clinical efficacies of alternative antibiotics such as tetracyclines to ensure effective treatment, mitigate antibiotic resistance, enhance clinical outcomes, and minimize the spread of resistant strains among MRMP-infected children. The objective of this study was to compare the therapeutic efficacies of macrolides and tetracyclines in treating MRMP pneumonia in children.
We systematically searched the literature to identify comparative studies that examined the clinical outcomes of macrolide and tetracycline antibiotics in children with MRMP pneumonia. We conducted a meta-analysis of the mean duration of fever, hospital stay duration, therapeutic efficacies, and time to defervescence to compare macrolides and tetracyclines.
Eleven studies involving 1143 patients compared the clinical efficacies of macrolides and tetracyclines in children with MRMP pneumonia. The studies were conducted in China, Japan, and Korea, and the outcomes of febrile days, hospital stay duration, therapeutic efficacy, and time to defervescence were analyzed. The macrolides studied were azithromycin and clarithromycin, whereas the tetracyclines included minocycline and doxycycline. The pooled estimate of 5 studies showed that the mean duration of febrile days and hospital stay was longer in the macrolides group than tetracycline group [weighted mean difference = 1.64 days, 95% confidence interval (CI): 0.68-2.59, weighted mean difference = 1.22 days, 95% CI: 0.82-1.62, respectively]. The therapeutic efficacy was significantly lower in the macrolide group than in the tetracycline group (odds ratio: 0.33, 95% CI: 0.20-0.57).
The clinical efficacy of tetracycline treatment was superior to that of macrolide treatment in children with MRMP pneumonia. However, further research is required to validate these findings and inform evidence-based clinical practice guidelines.
大环内酯类耐药肺炎支原体（MRMP）肺炎感染的全球患病率，尤其是在儿童中，正在上升。评估四环素等替代抗生素的临床疗效以确保有效治疗、减轻抗生素耐药性、改善临床结局并尽量减少耐药菌株在MRMP感染儿童中的传播势在必行。本研究的目的是比较大环内酯类药物和四环素类药物治疗儿童MRMP肺炎的疗效。
我们系统检索文献，以确定比较大环内酯类和四环素类抗生素治疗儿童MRMP肺炎临床结局的研究。我们对发热平均持续时间、住院时间、治疗效果和退热时间进行了荟萃分析，以比较大环内酯类药物和四环素类药物。
11项涉及1143例患者的研究比较了大环内酯类药物和四环素类药物治疗儿童MRMP肺炎的临床疗效。这些研究在中国、日本和韩国进行，并分析了发热天数、住院时间、治疗效果和退热时间等结局。所研究的大环内酯类药物为阿奇霉素和克拉霉素，而四环素类药物包括米诺环素和多西环素。5项研究的汇总估计显示，大环内酯类药物组的发热天数和住院时间的平均持续时间长于四环素类药物组[加权平均差分别为1.64天，95%置信区间（CI）：0.68 - 2.59；加权平均差为1.22天，95%CI：0.82 - 1.62]。大环内酯类药物组的治疗效果显著低于四环素类药物组（比值比：0.33，95%CI：0.20 - 0.57）。
在儿童MRMP肺炎中，四环素治疗的临床疗效优于大环内酯类治疗。然而，需要进一步研究来验证这些发现，并为循证临床实践指南提供依据。
