多西环素不同时间给药对大环内酯类耐药肺炎支原体肺炎患儿的影响  

Effect of doxycycline administered at different times on macrolide-resistant children with Mycoplasma pneumoniae pneumonia

作　　者：戴初凤 周芳 黄琴 邵启民 DAI Chufeng;ZHOU Fang;HUANG Qin;SHAO Qimin(Department of Rheumatology,Immunology and Nephrology,Hangzhou Children's Hospital,Hangzhou 310014,China)

机构地区：[1]杭州市儿童医院风湿免疫肾内科,杭州310014

出　　处：《药学前沿》2024年第11期431-437,共7页China Pharmacist

基　　金：浙江省医药卫生科技计划项目(2019KY525)。

摘　　要：目的评价多西环素(DOX)不同给药时间对大环内酯耐药肺炎支原体肺炎(MR-MPP)患儿的影响。方法分析2022年1月至2023年12月杭州市儿童医院诊断为MR-MPP患儿临床资料。根据治疗方案分为DOX组、静脉注射阿奇霉素改为口服DOX(ATD)组和单独静脉注射阿奇霉素(AZI)∶组。ATD组根据阿奇霉素治疗时间分为ATD1组(<3 d)和ATD2组(≥3d)。比较各组的临床症状,并采用倾向性评分匹配(PSM)对DOX+ATD1组和ATD2组患儿进行1MR-MPP患儿,DOX组、ATD组和AZI组分别为25例、85例和46例。与ATD组和AZI组相比,DOX组治疗后住院时间和发热时间较短,胸片改善率较高,糖皮质激素使用率低(P<0.05)。DOX组和ATD1组住院时间、治疗后发热持续时间和糖皮质激素使用率均低于ATD2组,且96 h退热率和胸部X线改善率高于ATD2组(P<0.05)。DOX组72h内退热率高于ATD1组和ATD2组(P<0.05)。PSM分析显示DOX+ATD1组的住院时间、治疗后发热时间和糖皮质激素使用率均低于ATD2组,72h退热率高于ATD2组(均P<0.05)。治疗期间未观察到与DOX相关的不良反应。结论早期(72 h内)口服DOX可显著改善MR-MPP患儿的临床疗效。Objective To evaluate the impact of different dosing times of doxycycline(DOX)on children with macrolide-resistant Mycoplasma pneumoniae pneumonia(MR-MPP).Methods Clinical data of children diagnosed with MR-MPP at Hangzhou Children's Hospital from January 2022 to December 2023 were analyzed.Children were divided into three groups based on treatment regimens:the doxycycline(DOX)group,the intravenous azithromycin converted to oral DOX(ATD)group,and the intravenous azithromycin alone(AZI)group..The ATD group was further divided into ATD1 group(<3 days)and ATD2 group(≥3 days)according to the duration of azithromycin treatment.Clinical symptoms of each group were compared,and propensity score matching(PSM)analysis was used for adjustment.Results A total of 156 children with MR-MPP were included in the study,with 25 in the DOX group,85 in the ATD group,and 46 in the AZI group.Compared with the ATD and AZI groups,the DOX group had a shorter hospital stay and fever duration,higher chest radiograph improvement rate,and lower glucocorticoid usage rate(P<0.05).The DOX group and ATD1 group had lower hospital stays,post-treatment fever durations,and glucocorticoid usage rates than the ATD2 group,and higher 96-hour fever resolution rates and chest X-ray improvement rates than the ATD2 group(P<0.05).The DOX group had a higher fever resolution rate within 72 hours compared to the ATD1 and ATD2 groups(P<0.05).PSM analysis showed that the DOX-ATD1 group had a lower hospital stay,post-treatment fever duration,and glucocorticoid usage rate than the ATD2 group,and a higher 72-hour fever resolution rate than the ATD2 group(all P<0.05).No adverse reactions related to DOX were observed during the treatment period.Conclusion Early oral administration of DOX within 72 hours can significantly improve the clinical efficacy in children with MR-MPP.

关 键 词：大环内酯耐药 肺炎支原体 多西环素 阿奇霉素 倾向评分匹配 糖皮质激素 不良反应 

分 类 号：R969.4[医药卫生—药理学]