Therapeutic Efficacy and Safety of Prolonged Macrolide, Corticosteroid, Doxycycline, and Levofloxacin against Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children

Ha, Seok Gyun; Oh, Kyung Jin; Ko, Kwang-Pil; Sun, Yong Han; Ryoo, Eell; Tchah, Hann; Jeon, In Sang; Kim, Hyo Jeong; Ahn, Jung Min; Cho, Hye-Kyung

In some previous reports, systemic CST induced clinical and radiological improvement in severe refractory MP pneumonia. 25, 26, 31 Immune regulatory and anti-inflammatory effects of CST could result in the clinical improvement of severe refractory MP pneumonia. 32, 33 In this study, CST improved fever in the shortest time (8.4 ± 26.8 hours) compared with other medications, which was similar to those reported in other studies. Lee et al. 34 reported that 93% of patients with severe MP pneumonia achieved defervescence within 24 hours. In another study, the TTD was approximately 8-48 hours in prednisolone-treated patients. 25 Recently, several studies suggested that tetracycline and fluoroquinolone had a therapeutic effect on MRMP in children. Most patients administered DXC or minocycline achieved defervescence within 24 hours, with a significantly shorter TTD than macrolide in the MRMP group (13.5 ± 4.1 vs. 123.3 ± 59 .0 hours). 21, 35 Miyashita et al. 36 reported that 77% of patients with MRMP in the quinolone group achieved defervescence within 48 hours after the initiation of antibiotics and quinolone was more effective than macrolide for MRMP treatment (P = 0.036). In this study, TTD after DXC and LFX treatment was 27.4 ± 33.2 hours and 16.8 ± 18 .0 hours, respectively. In addition, 85.7% and 83.3% of patients achieved defervescence within 48 hours in the DXC and LFX groups, respectively ( Table 2) . Direct comparison of TTD between the PMC group and the secondary treatment groups was not possible, because all patients were initially treated with macrolide and added on or switched to CST, DXC, and LFX. Therefore, we performed PS matching to adjust differences in baseline characteristics among the groups and compared TTD after initial macrolide treatment between groups. However, the TTDs after initial macrolide treatment of the CST, DXC, LFX groups did not differ from that of each matched PMC group (P = 0.085, P = 0.453, and P = 0.283, respectively). There was no difference in length of hospital stay between the PMC group and the secondary treatment groups ( Table 3) .