儿童大环内酯类无反应性肺炎支原体肺炎延长阿奇霉素与换用多西环素的疗效研究

Efficacy of prolonged azithromycin versus switching to doxycycline in the treatment of macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children

摘要:

目的 比较儿童大环内酯类无反应性肺炎支原体肺炎（macrolide-unresponsive Mycoplasma pneumoniae pneumonia, MUMPP）延长阿奇霉素（prolonged azithromycin, PAZM）与换用多西环素（switching to doxycycline, SDXC）的疗效和安全性。方法 选取2023年1—12月于宝鸡市中心医院住院的173例MUMPP患儿为研究对象，根据初始大环内酯类药物治疗72 h后二次抗生素的选择分为PAZM组和SDXC组，比较两组疗效、药物不良反应，分析难治性肺炎支原体肺炎（refractory Mycoplasma pneumoniae pneumonia, RMPP）的危险因素。结果 SDXC组退热时间、咳嗽缓解时间、糖皮质激素使用率均短于或低于PAZM组（P<0.05），肺部病灶吸收率高于PAZM组（P<0.05）。两组均未发生肝肾功能损伤和牙齿变色等不良反应。PAZM组中有47例发生RMPP。单因素分析显示乳酸脱氢酶及年龄是RMPP的危险因素（P<0.05）。结论 MUMPP患儿中SDXC组疗效优于PAZM组，多西环素短期使用相对安全。

Abstract:

Objective To investigate the efficacy and safety of prolonged azithromycin (PAZM) versus switching to doxycycline (SDXC) in the treatment of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children.Methods A total of 173 children with MUMPP who were hospitalized in Baoji Central Hospital, from January to December 2023 were selected as subjects. According to the choice of secondary antibiotic after 72 hours of initial macrolide therapy, they were divided into two groups: PAZM and SDXC. The efficacy and adverse drug reactions were compared between the two groups, and the risk factors for refractory Mycoplasma pneumoniae pneumonia (RMPP) were analyzed.Results Compared with the PAZM group, the SDXC group had significantly shorter time to defervescence and time to cough relief, a significantly lower proportion of patients using glucocorticoids, and a significantly higher proportion of patients with lung lesion absorption (P<0.05). No adverse reactions such as liver and kidney function impairment and tooth discoloration were observed in either group. RMPP occurred in 47 cases in the PAZM group. The univariate analysis showed that lactate dehydrogenase levels and age were risk factors for RMPP (P<0.05).Conclusions The efficacy of SDXC is superior to that of PAZM in children with MUMPP, and short-term use of doxycycline is relatively safe.