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. 2018 Sep 18;33(43):e268.
doi: 10.3346/jkms.2018.33.e268. eCollection 2018 Oct 22.

Therapeutic Efficacy and Safety of Prolonged Macrolide, Corticosteroid, Doxycycline, and Levofloxacin against Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children

Seok Gyun Ha  1 , Kyung Jin Oh  1 , Kwang-Pil Ko  2 , Yong Han Sun  1 , Eell Ryoo  1 , Hann Tchah  1 , In Sang Jeon  1 , Hyo Jeong Kim  1 , Jung Min Ahn  1 , Hye-Kyung Cho  1
Affiliations

Therapeutic Efficacy and Safety of Prolonged Macrolide, Corticosteroid, Doxycycline, and Levofloxacin against Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children

Seok Gyun Ha et al. J Korean Med Sci. .

Abstract

Background: We aimed to compare the therapeutic efficacy of prolonged macrolide (PMC), corticosteroids (CST), doxycycline (DXC), and levofloxacin (LFX) against macrolide-unresponsive Mycoplasma pneumoniae (MP) pneumonia in children and to evaluate the safety of the secondary treatment agents.

Methods: 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.

Results: 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, P = 0.085), PMC and DXC groups (4.9 vs. 5.7 days, P = 0.453), and PMC and LFX groups (4.4 vs. 5.0 days, P = 0.283). No side effects were observed in the CST, DXC, and LFX groups.

Conclusion: 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.

Keywords: Antibiotics; Mycoplasma pneumoniae; Pneumonia.

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Conflict of interest statement

Disclosure: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. The comparison of TTD after secondary treatment between the CST, DXC, and LFX groups.
The box displays range from the first quartile to the third quartile and midline of box represents median of TTD after secondary treatment. Error bars represent minimum and maximum of TTD after secondary treatment. TTD = time to defervescence, CST = corticosteroid, DXC = doxycycline, LFX = levofloxacin.
See this image and copyright information in PMC

Comment in

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