Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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Therapeutic Efficacy and Safety of Prolonged Macrolide, Corticosteroid, Doxycycline, and Levofloxacin against Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children

  • Ha, Seok Gyun (Department of Pediatrics, Gachon University College of Medicine) ;
  • Oh, Kyung Jin (Department of Pediatrics, Gachon University College of Medicine) ;
  • Ko, Kwang-Pil (Department of Preventive Medicine, Gachon University College of Medicine) ;
  • Sun, Yong Han (Department of Pediatrics, Gachon University College of Medicine) ;
  • Ryoo, Eell (Department of Pediatrics, Gachon University College of Medicine) ;
  • Tchah, Hann (Department of Pediatrics, Gachon University College of Medicine) ;
  • Jeon, In Sang (Department of Pediatrics, Gachon University College of Medicine) ;
  • Kim, Hyo Jeong (Department of Pediatrics, Gachon University College of Medicine) ;
  • Ahn, Jung Min (Department of Pediatrics, Gachon University College of Medicine) ;
  • Cho, Hye-Kyung (Department of Pediatrics, Gachon University College of Medicine)
  • Received : 2018.02.10
  • Accepted : 2018.07.05
  • Published : 2018.10.22
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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 ${\geq}38.0^{\circ}C$ at ${\geq}72$ 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

References

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