ObjectiveTo systemically review the efficacy and safety of moxifloxacin for mycoplasma pneumoniae. MethodsSuch databases as PubMed, The Cochrane library (Issue 4, 2014), ISI, CBM, CNKI, VIP and WanFang Data were searched from inception to April 2014 for randomized controlled trials (RCTs) concerning moxifloxacin for mycoplasma pneumoniae. Two reviewers screened literature according to the inclusion and exclusion criteria, extract data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 401 patients were included. The results of meta-analysis showed that:compared with erythrocin or azithromycin, moxifloxacin had higher recovery rate (OR=2.35, 95%CI 1.76 to 3.15, P<0.000 01), higher bacterium negative rate (OR=3.74, 95%CI 1.76 to 7.96, P=0.000 6), and shorter fever clearance time (MD=-1.07, 95%CI -1.43 to -0.71, P<0.000 01); compared with azithromycin alone, moxifloxacin combined with azithromycin had higher recovery rate (OR=1.63, 95%CI 1.09 to 2.42, P=0.02), higher bacterium negative rate (OR=5.78, 95%CI 2.41 to 13.84, P<0.000 1), and shorter fever clearance time (MD=-0.99, 95%CI -1.52 to -0.47, P=0.000 2). In addition, there was a lower incidence of liver damage (OR=0.16, 95%CI 0.04 to 0.72, P=0.02) in patients who took moxifloxacin compared with erythromycin or azithromycin. No significant difference was found in the incidence of gastrointestinal adverse reaction between the two groups. ConclusionMoxifloxacin for mycoplasma pneumonia is more effective than macrolides (erythrocin or azithromycin) with a lower incidence of adverse reaction. Due to limited quantity and quality of the included studies, the above conclusion should be further verified by conducting more high quality, large scale, multicentre RCTs.
ObjectiveTo systematically review the risk factors of refractory mycoplasma pneumoniae pneumonia (RMPP) in children. MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM, VIP, and WanFang Data databases were electronically searched for case-control studies and cohort studies on the risk factors of RMPP in children from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 27 case-control studies involving 3 967 children with RMPP and 11 613 children with common MPP were included. The results of meta-analysis showed that heat course (OR=2.07, 95%CI 1.98 to 2.16, P<0.000 01), length of hospital stay (OR=1.42, 95%CI 1.14 to 1.69, P<0.000 01), recurrent respiratory tract infection (OR=8.51, 95%CI 6.15 to 11.77, P<0.000 01), level of IL-6 (OR=21.95, 95%CI 20.85 to 23.06, P<0.000 01), level of CRP (OR=2.41, 95%CI 1.94 to 2.87, P<0.000 01), level of LDH (OR=0.79, 95%CI 0.53 to 1.06, P<0.000 01), level of ESR (OR=2.65, 95%CI 1.13 to 4.18, P=0.000 6), combined pleural effusion (OR=9.42, 95%CI 3.65 to 24.31, P<0.000 01), combined with extrapulmonary complications (OR=3.33, 95%CI 2.42 to 4.58, P<0.000 01), large lung consolidation (OR=12.31, 95%CI 5.42 to 27.99, P<0.000 01) were the risk factors for RMPP. ConclusionsCurrent evidence indicates that heat course, length of hospital stay, repeated respiratory tract infection, high level of IL-6, high level of CRP, high level of LDH, high level of ESR, combined pleural effusion, combined extrapulmonary complications, and large lung consolidation are risk factors for children with RMPP. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo explore the application and clinical value of metagenomic next-generation sequencing (mNGS) combined with Omadacycline in the treatment of Refractory Mycoplasma pneumoniae pneumonia (RMPP).MethodsThe clinical data, relevant laboratory results, diagnosis and treatment process, and imaging outcomes of four patients diagnosed with Mycoplasma pneumoniae pneumonia through mNGS were analyzed. ResultsThe clinical symptoms at onset in all four patients were consistent with Mycoplasma pneumoniae pneumonia. After conventional treatment with macrolides, tetracyclines, or quinolone antibiotics, the symptoms showed no significant improvement, and there was a trend of radiological worsening. Following the confirmation of Mycoplasma pneumoniae infection through mNGS of bronchoalveolar lavage fluid, and due to various reasons preventing the use of the aforementioned drugs, omadacycline was ultimately chosen for treatment. Radiological improvements were observed in all cases, leading to a good prognosis and discharge. ConclusionsFor pneumonia cases where the infectious pathogen cannot be identified and conventional treatment has failed, mNGS can be utilized for early and accurate diagnosis. In cases of RMPP, Omadacycline can be employed as an alternative treatment to prevent delays in care and reduce the risk of complications.