Efficacy and safety of doxycycline for severe Mycoplasma pneumoniae pneumonia in pediatric patients

Abstract

This study evaluated the efficacy and safety of doxycycline in treating Severe Mycoplasma pneumoniae Pneumonia (SMPP) in children under eight years old through clinical analysis and meta-analysis. A total of 92 pediatric SMPP cases were divided into a doxycycline treatment group (44 cases) and a macrolides control group (48 cases). Compared to the control group, the doxycycline group exhibited significantly shorter cough relief time (5.4 ± 1.2 vs. 7.2 ± 1.6 days, p < 0.05) and pulmonary rale resolution time (6.2 ± 1.3 vs. 8.0 ± 1.7 days, p < 0.05). The overall treatment efficacy rate was higher in the doxycycline group (88.6% vs. 75.0%, p < 0.05). No significant differences were found in fever resolution time or hospitalization duration (p > 0.05). Safety analysis revealed comparable adverse event rates between groups (18.2% vs. 16.7%, p > 0.05), primarily mild rash and gastrointestinal discomfort, with no tooth discoloration observed. The meta-analysis confirmed the advantages of doxycycline, demonstrating superior treatment efficacy (RR: 0.68, 95% CI: 0.58-0.79), shorter fever resolution (MD: - 1.5 days, 95% CI: - 2.3 to - 0.7), and faster cough and pulmonary rale resolution. Adverse events were similar across groups. These findings highlight doxycycline's clinical efficacy and safety in SMPP treatment, providing strong evidence for its application in pediatric practice.

Keywords: Antibiotic therapy in children; Doxycycline; Efficacy and safety; Meta-analysis; Pediatric respiratory infection; Severe Mycoplasma pneumoniae pneumonia.

Fig. 1

Patient inclusion and exclusion flowchart

Fig. 2

The incidence of pleural effusion is significantly higher in the doxycycline treatment group compared to the control group

Fig. 3

Comparison of microscopic findings and BAL frequency between doxycycline and control groups in pediatric patients. Note A Comparison of light and heavy microscopic findings between experimental and control groups; B comparison of bal frequency between experimental and control groups

Fig. 4

Comparison of clinical observation indicators between the doxycycline and control groups. Note A Comparison of fever resolution time: bar chart showing the median (p50) and interquartile range (p25, p75) of fever resolution time in both groups. Statistical analysis was performed using the rank-sum test, p > 0.05. B Comparison of cough relief time: box plot showing the cough relief time in the doxycycline group (n = 44) and the control group (n = 48). Statistical analysis was performed using the t-test, *p < 0.05. C Comparison of lung rales disappearance time: box plot showing the lung rales disappearance time in both groups. Statistical analysis was performed using the t-test, *p < 0.05. D Comparison of hospital stay: box plot showing the hospital stay in both groups. Statistical analysis was performed using the t-test, p > 0.05

Fig. 5

Literature screening process and quality assessment of included studies. Note A Flowchart of the literature inclusion process; B summary of bias risk assessment for the included studies

Fig. 6

Forest plot of the meta-analysis. Note A Forest plot of the meta-analysis on the treatment efficacy of doxycycline for children with SMPP; B forest plot of the meta-analysis on fever resolution time in children treated with doxycycline for SMPP; C forest plot of the meta-analysis on cough resolution time in children treated with doxycycline for SMPP; D forest plot of the meta-analysis on lung rales resolution time in children treated with doxycycline for SMPP

Fig. 7

Sensitivity analysis forest plots. Note A Sensitivity analysis of treatment efficacy for doxycycline in children with SMPP; B sensitivity analysis of fever resolution time for doxycycline in children with SMPP; C sensitivity analysis of cough relief time for doxycycline in children with SMPP; D sensitivity analysis of lung rales resolution time for doxycycline in children with SMPP

Fig. 8

Publication of bias test results for meta-analysis. Note A Publication bias test results for treatment efficacy of doxycycline in children with SMPP; B publication bias test results for fever resolution time in children with SMPP treated with doxycycline; C publication bias test results for cough relief time in children with SMPP treated with doxycycline; D publication bias test results for lung rales resolution time in children with SMPP treated with doxycycline