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Meta-Analysis
. 2020 May 29;99(22):e20121.
doi: 10.1097/MD.0000000000020121.

Efficacy and safety of azithromycin combined with glucocorticoid on refractory Mycoplasma pneumoniae pneumonia in children: A PRISMA-compliant systematic review and meta-analysis

Jian-Li Qiu  1 , Li Huang  2 , Ming-Yi Shao  3 , Yu-Na Chai  4 , Hui-Juan Zhang  1 , Xiang-Feng Li  1 , Xiao-Xu Sun  1 , Qian-Yi Zhao  1 , Fei Duan  5 , Wen-Sheng Zhai  1
Affiliations
Meta-Analysis

Efficacy and safety of azithromycin combined with glucocorticoid on refractory Mycoplasma pneumoniae pneumonia in children: A PRISMA-compliant systematic review and meta-analysis

Jian-Li Qiu et al. Medicine (Baltimore). .

Abstract

Introduction: The aim of this study was to evaluate the efficacy and safety of azithromycin (AZI) combined with glucocorticoid (GC) in the treatment of children with refractory Mycoplasma pneumoniae.

Methods: Computer search for PubMed, EMbase, Cochrane Library, China Biomedical Literature Database (CBMdisc), China Knowledge Network (CNKI), Wanfang, VIP (VIP), and a randomized controlled trial (RCT) of AZI combined with GC in the treatment of children with refractory Mycoplasma pneumoniae pneumonia test (RCT), the search time limit is built until March 20, 2019. Two researchers independently performed literature screening, data extraction, and literature risk bias, and meta-analysis was performed using RevMan 5.3 software.

Results: A total of 12 RCTs were included, including 1130 patients. Meta-analysis showed that AZI combined with GC therapy significantly improved the total effective rate of the disease compared with the conventional treatment group (odds ratio [OR] = 6.37; 95% confidence interval [CI] 4.03, 10.07; P < .00001; I = 0%), effectively shortened the antipyretic time (SMD = -2.29; 95% CI -2.70, -1.88; P < .0001); promoted lung inflammation absorption (SMD = -1.89; 95% CI -2.38, -1.40; P < .0001), reduced cough time (SMD = -2.39; 95% CI -2.80, -1.99; P < .0001); shortened hospital stay (SMD = -2.19; 95% CI -3.21, -1.17; P < .0001); improved imaging findings (OR = 5.38; 95% CI 1.09, 26.51, P = .04); reduced inflammation index (SMD = -3.15; 95% CI -4.93, -1.36; P = .004); improved immune function (SMD = 1.29; 95% CI -0.02, 2.60; P < .0001); had no significant adverse reactions (OR = 1.18; 95% CI 0.71, 1.98; P = .53).

Conclusions: According to the current limited research evidence, the addition of GCs to the conventional treatment of refractory Mycoplasma pneumoniae in children can improve the clinical efficacy to a certain extent, and the safety is better. However, due to the quality and quantity of the included literature, the conclusions of this study need to be confirmed by more high-quality studies.

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Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Flowchart depicting the identification and selection of relevant studies.
Figure 2
Figure 2
Meta-analysis of the effect of AZI + GC on total effective rate. AZI = azithromycin, GC = glucocorticoid.
Figure 3
Figure 3
Meta-analysis of the effect of AZI + GC on remission time of clinical symptom. AZI = azithromycin, GC = glucocorticoid.
Figure 4
Figure 4
Meta-analysis of the effect of AZI + GC on hospital stay. AZI = azithromycin, GC = glucocorticoid.
Figure 5
Figure 5
Meta-analysis of the effect of AZI + GC on image changes AZI = azithromycin, GC = glucocorticoid.
Figure 6
Figure 6
Meta-analysis of the effect of AZI + GC on changes of inflammatory markers. AZI = azithromycin, GC = glucocorticoid.
Figure 7
Figure 7
Meta-analysis of the effect of AZI + GC on adverse reactions. AZI = azithromycin, GC = glucocorticoid.
See this image and copyright information in PMC

References

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    1. Bu XF, Kong ZY, Wang J. Pathogenesis and progress of diagnosis and treatment of refractory mycoplasma pneumonia in children (China). Guangdong Medical Journal 2018;39:295–8.

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