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Sheng Y, Liang Y, Zhao C, Kang D, Liu X. Azithromycin sequential therapy plus inhaled terbutaline for Mycoplasma Pneumoniae pneumonia in children: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:653. [PMID: 38944667 PMCID: PMC11214698 DOI: 10.1186/s12879-024-09564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy. METHODS This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42023452139). A PRISMA-compliant systematic review and meta-analysis was performed. Six English and four Chinese databases were comprehensively searched up to June, 2023. RCTs of azithromycin sequential therapy plus inhaled terbutaline were selected. The revised Cochrane risk of bias tool for randomized trials (RoB2) was used to evaluate the methodological quality of all studies, and meta-analysis was performed using Stata 15.0 with planned subgroup and sensitivity analyses. Publication bias was evaluated by a funnel plot and the Harbord' test. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. RESULTS A total of 1,938 pediatric patients from 20 RCTs were eventually included. The results of meta-analysis showed that combined therapy was able to significantly increase total effectiveness rate (RRβ=β1.20, 95%CI 1.15 to 1.25), forced expiratory volume in one second (SMDβ=β1.14, 95%CIs, 0.98 to 1.29), the ratio of forced expiratory volume in one second/forced vital capacity (SMDβ=β2.16, 95%CIs, 1.46 to 2.86), peak expiratory flow (SMDβ=β1.17, 95%CIs, 0.91 to 1.43). The combined therapy was associated with a 23% increased risk of adverse reactions compared to azithromycin therapy alone, but no significant differences were found. Harbord regression showed no publication bias (Pβ
= 0.148). The overall quality of the evidence ranged from moderate to very low. CONCLUSIONS This first systematic review and meta-analysis suggested that azithromycin sequential therapy plus inhaled terbutaline was safe and beneficial for children with MPP. In addition, the combined therapy represented significant improvement of PVF. Due to lack of high-quality evidence, our results should be confirmed by adequately powered RCTs in the future.
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Affiliation(s)
- Yongcheng Sheng
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yi Liang
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Chongyang Zhao
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Deying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xueting Liu
- West China Hospital, "Double First-class" Construction office, Sichuan University, Chengdu, Sichuan, China.
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Gan T, Yu J, He J. miRNA, lncRNA and circRNA: targeted molecules with therapeutic promises in Mycoplasma pneumoniae infection. Arch Microbiol 2023; 205:293. [PMID: 37477725 DOI: 10.1007/s00203-023-03636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
Mycoplasma pneumoniae (MP) is primarily recognized as a respiratory pathogen that causes community-acquired pneumonia, which can lead to acute upper and lower airway inflammation and extrapulmonary syndrome. Refractory pneumonia caused by MP can cause severe complications and even be life-threatening, particularly in infants and the elderly. It is well-known that non-coding RNAs (ncRNAs) represented by miRNAs, lncRNAs and circRNAs have been manifested to be widely involved in the regulation of gene expression. Growing evidence indicates that these ncRNAs have distinct differentiated expression in MP infection and affect multiple biological processes, playing an indispensable role in the initiation and promotion of MP infection. However, the epigenetic mechanisms involved in the development of MP infection remain unclear. This article reviews the mechanisms by which miRNAs, lncRNAs, and circRNAs mediate MP infection, such as inflammatory responses, apoptosis and pulmonary fibrosis. Focusing on miRNAs, lncRNAs and circRNAs associated with MP infection could provide new insights into this disease's early diagnosis and therapeutic approaches.
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Affiliation(s)
- Tian Gan
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Jianwei Yu
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Jun He
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China.
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Efficacy and Safety of Integrated Maxing Shigan Decoction and Azithromycin for Mycoplasma Pneumoniae Pneumonia in Children: A Systematic Review and Meta-Analysis. J Clin Pharm Ther 2023. [DOI: 10.1155/2023/2596562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background. The primary objective of this study was to thoroughly assess the effectiveness of treating pediatric mycoplasma pneumoniae pneumonia (MPP) with Maxing Shigan decoction (MSD) and azithromycin. Materials and Methods. We comprehensively reviewed the literature for randomized controlled trials research on MPP treated by MSD combined with azithromycin in children in the databases of Medicine, Embase, ClinicalTrials.gov, Cochrane Library, PubMed, CNKI, WangFang, and VIP from inception to April 2021. dds ratio (OR) was used for dichotomous data, while the mean difference (MD) was adopted for continuous variables as effect size, both of which were demonstrated in effect size and 95% confidence intervals (CI). Results. A total of 49 studies with 5704 patients were included in the meta-analysis. The results showed that MSD combined with azithromycin significantly improved the clinical efficacy (ORβ=β5.31, 95% CI: (4.35, 6.49), and
) and reduced the chest X-rays recovery time (MDβ=ββ2.25, 95% CI: (β2.86, β1.65), and
), cough duration (MDβ=ββ2.53, 95% CI: (β2.93. β2.12), and
), CRP (MDβ=ββ7.84, 95% CI: (β9.51, β6.17), and
), fever duration (MDβ=ββ1.53, 95% CI: (β1.78, β1.28), and
), hospital days (MDβ=ββ2.70, 95% CI: (β3.35, β2.06), and
), moist rales duration (MDβ=ββ2.00, 95% CI: (β2.33, β1.68), and
), and adverse effects (ORβ=β0.55, 95% CI: (0.41, 0.75), and
) when compared with azithromycin alone in the treatment of MPP in children. Meta-regression analysis demonstrated that the course of disease and duration of medication contribute to the heterogeneity across studies when comparing outcomes between groups. Conclusion. MSD and azithromycin worked better when used in conjunction to treat MPP in young patients. These findings require confirmation by additional high-quality, big sample RCTs.
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Guo JN, Bai X, Zhang HX, Zhang N, Liang JM, Guo ZY, Cui X. Efficacy and safety of Chinese herbal medicine for pneumonia convalescence in children: A systematic review and meta-analysis. Front Pharmacol 2022; 13:956736. [PMID: 36120373 PMCID: PMC9479002 DOI: 10.3389/fphar.2022.956736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Chinese herbal medicine (CHM) has advantages in treating sequela symptoms of pediatric pneumonia convalescence. Hence, this study aims to evaluate the efficacy and safety of CHM using a meta-analysis approach. Methods: The randomized controlled trials (RCTs) that met the search strategy were selected from seven databases from the inception date to December 17, 2021. Based on the Cochrane handbook, the quality of the selected studies was assessed using the risk of bias. Data were expressed as relative risk (RR) or mean difference (MD) and with 95% confidence interval (CI). Subgroup analyses and sensitivity analyses were performed. The Grading Recommendation Assessment, Development, and Evaluation (GRADE) method was used to assess the evidence certainty. Result: Twenty RCTs with 2,241 participants were identified using the search criteria. CHMs included Danshen injection, Liujunzi decoction, Qingfei Tongluo decoction, Yiqi Huoxue decoction, Yupingfeng granule, XiaoErFeiKe granule, Sha-Sheng-Mai-Dong decoction, and so on. Results indicated that CHM combined with Western medicine (WM) or CHM alone improved the total clinical effective rate (RR = 1.22; 95% CI: 1.15β1.29), reduced cough relief time (MD = β2.16; 95% CI: β2.46 to β1.85), lung rales disappearance time (MD = β1.82; 95% CI: β2.17 to β1.47), and length of hospital stay (MD = β2.01, 95% CI: β3.81 to β0.22) in the treatment of pneumonia convalescence in children. However, there was no significant statistical difference regarding the incidence of adverse reactions (RR = 0.57; 95% CI: 0.23β1.43). Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/; Identifier CRD42022298936
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Affiliation(s)
- Jian-Ning Guo
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Xue Bai
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Xian Zhang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Ning Zhang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Jun-Ming Liang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Zi-Yi Guo
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Xia Cui
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- *Correspondence: Xia Cui,
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Study on the Therapeutic Effect of Azithromycin Combined with Glucocorticoid on Pulmonary Function and Inflammatory Response in Children with Pneumonia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5288148. [PMID: 35388320 PMCID: PMC8977326 DOI: 10.1155/2022/5288148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/28/2022]
Abstract
Objective The objective is to explore the efficacy of azithromycin combined with glucocorticoids in the treatment of children with pneumonia and its effect on the inflammatory response. Methods A total of 86 children with pneumonia were divided into the experimental group (EG) and the control group (CG). Both groups received conventional treatment, the CG was treated with azithromycin and the EG was additionally treated with glucocorticoid methylprednisolone. The therapeutic effect, disappearance time of clinical symptoms, pulmonary function, inflammatory factors, immune function, quality of life, and adverse reactions were measured in the two groups. Results After treatment, compared with CG, the total effective rate was significantly elevated, the disappearance time of various clinical symptoms was earlier, and various pulmonary function indexes were increased in the EG. The interleukin-6 (IL-6), tumor necrosis factor-Ξ± (TNF-Ξ±), C reactive protein (CRP), and CD8+ levels were reduced, and CD3+ and CD4+ levels were increased in the EG. The quality-of-life scores were upregulated in the EG. Moreover, there was no significant difference in the incidence of adverse reactions between the two groups. Conclusion The combined use of azithromycin and glucocorticoids in the treatment of children with Mycoplasma pneumoniae infection has a good curative effect, can significantly improve lung function, restore pulmonary inflammatory indexes to normal, and enhance patients' immune function and improve their quality of life, with fewer adverse reactions and safety.
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