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Meta-Analysis
. 2021 Sep 25;21(1):1003.
doi: 10.1186/s12879-021-06508-7.

Efficacy of tetracyclines and fluoroquinolones for the treatment of macrolide-refractory Mycoplasma pneumoniae pneumonia in children: a systematic review and meta-analysis

Jong Gyun Ahn #  1   2 , Hye-Kyung Cho #  3 , Donghe Li  4 , Miyoung Choi  5 , Jina Lee  6 , Byung-Wook Eun  7 , Dae Sun Jo  8 , Su Eun Park  9 , Eun Hwa Choi  10 , Hyeon-Jong Yang  11 , Ki Hwan Kim  12   13
Affiliations
Meta-Analysis

Efficacy of tetracyclines and fluoroquinolones for the treatment of macrolide-refractory Mycoplasma pneumoniae pneumonia in children: a systematic review and meta-analysis

Jong Gyun Ahn et al. BMC Infect Dis. .

Abstract

Background: Mycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia in school-age children. Macrolides are considered a first-line treatment for M. pneumoniae infection in children, but macrolide-refractory M. pneumoniae (MRMP) strains have become more common. In this study, we assessed the efficacy of tetracyclines and fluoroquinolones in MRMP treatment in children through a systematic review and meta-analysis.

Methods: Two reviewers individually searched 10 electronic databases (Medline/Pubmed, Embase, the Cochrane Library, and core Korean, Chinese, and Japanese journals) for papers published from January 1, 1990 to March 8, 2018. The following data for each treatment group were extracted from the selected studies: intervention (tetracyclines and fluoroquinolones/comparator), patient characteristics (age and sex), and outcomes (fever duration, hospital stay length, treatment success rate, and defervescence rates 24, 48, and 72 h after starting treatment).

Results: Eight studies involving 537 participants were included. Fever duration and hospital stay length were shorter in the tetracycline group than in the macrolide group (weighted mean difference [WMD] = - 1.45, 95% confidence interval [CI]: - 2.55 to - 0.36, P = 0.009; and WMD = - 3.33, 95% CI: - 4.32 to - 2.35, P < 0.00001, respectively). The therapeutic efficacy was significantly higher in the tetracycline group than in the macrolide group (odds ratio [OR]: 8.80, 95% CI: 3.12-24.82). With regard to defervescence rate, patients in the tetracycline group showed significant improvement compared to those in the macrolide group (defervescence rate after 24 h, OR: 5.34, 95% CI: 1.81-15.75; after 48 h, OR 18.37, 95% CI: 8.87-38.03; and after 72 h, OR: 40.77, 95% CI: 6.15-270.12). There were no differences in fever improvement within 24 h in patients in the fluoroquinolone group compared to those in the macrolide group (OR: 1.11, 95% CI: 0.25-5.00), although the defervescence rate was higher after 48 h in the fluoroquinolone group (OR: 2.78, 95% CI: 1.41-5.51).

Conclusion: Tetracyclines may shorten fever duration and hospital stay length in patients with MRMP infection. Fluoroquinolones may achieve defervescence within 48 h in patients with MRMP infection. However, these results should be carefully interpreted as only a small number of studies were included, and they were heterogeneous.

Keywords: Child; Fluoroquinolone; Macrolide-resistant; Mycoplasma pneumoniae; Tetracycline.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Flowchart of the selection process of studies included in the meta-analysis
Fig. 2
Fig. 2
Comparison of fever duration between patients treated with tetracyclines and those treated with macrolides
Fig. 3
Fig. 3
Comparison of hospital stay length between patients treated with tetracyclines and those treated with macrolides
Fig. 4
Fig. 4
Comparison of treatment efficacy between patients treated with tetracyclines and those treated with macrolides
Fig. 5
Fig. 5
Forest plots of defervescence rates in patients treated with tetracyclines or macrolides. The defervescence rates at 24 h (a), 48 h (b), and 72 h (c) are shown
Fig. 6
Fig. 6
Forest plots of defervescence rates in patients treated with tosufloxacin or macrolides. The defervescence rates at 24 h (a) and 48 h (b) are shown
Fig. 7
Fig. 7
Forest plot of 48-h defervescence rates in patients treated with tosufloxacin or tetracyclines
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