肺炎支原体(MP)是儿童和青少年社区获得性肺炎的重要原因。尽管大环内酯类抗生素作为一线治疗有效,持续发烧和/或临床恶化有时会使治疗复杂化,甚至可能导致严重的全身性疾病.迄今为止,对替代治疗方案没有共识,最佳剂量,和治疗严重的持续时间,进步,大环内酯类药物治疗失败后的全身性MP肺炎。大环内酯耐药MP肺炎和难治性MP肺炎是临床上遇到的两种主要复杂疾病。目前,在东亚,绝大多数MP分离株对大环内酯类药物具有抗性,尤其是中国,而在欧洲和北美,而在欧洲和北美的患病率远低于亚洲,各国不同。肺炎的严重程度和肺外表现可能反映宿主免疫反应的强度或细菌感染的传播。感染大环内酯类耐药MP菌株并接受大环内酯类治疗的儿童在延长抗生素治疗后会出现持续发热,并且MP-DNA载量下降幅度最小。替代的二线药物,如四环素(多西环素或米诺环素)和氟喹诺酮(环丙沙星或左氧氟沙星)可能会导致儿童大环内酯治疗失败后的临床改善。难治性MP肺炎反映了由于对感染的过度免疫反应而导致的临床和放射学发现的恶化。免疫调节剂如皮质类固醇和静脉注射免疫球蛋白(IVIG)在治疗难治性MP肺炎中显示出有希望的结果。特别是与适当的抗菌药物联合使用时。尽管以标准剂量静脉注射甲基强的松龙进行皮质类固醇治疗,但皮质类固醇耐药的高炎性MP肺炎代表持续或复发的发烧。
结论:本报告总结了大环内酯耐药和难治性MP肺炎的临床意义,并讨论了替代药物的疗效和安全性,从临床实践的角度建议逐步管理MP肺炎。
背景:•尽管MP肺炎通常是良性的自限性感染,以反应性大环内酯类药物作为一线治疗,如果不能有效实施其他治疗策略,可能会出现严重的危及生命的病例.•大环内酯耐药和难治性MP肺炎是两种可能使MP肺炎的临床过程复杂化的疾病。增加恶化甚至死亡的风险。
背景:•本报告总结了大环内酯耐药和难治性MP肺炎的临床相关性,并讨论了替代药物疗法的疗效和安全性。•基于对现有证据和专家意见的综合分析,开发了一种实用的逐步管理MP肺炎的方法。
Mycoplasma pneumoniae (MP) is an important cause of community-acquired pneumonia in children and young adolescents. Despite
macrolide antibiotics effectiveness as a first-line therapy, persistence of fever and/or clinical deterioration sometimes may complicate treatment and may even lead to severe systemic disease. To date, there is no consensus on alternative treatment options, optimal dosage, and duration for treating severe, progressive, and systemic MP pneumonia after
macrolide treatment failure.
Macrolide-resistant MP pneumonia and refractory MP pneumonia are the two major complex conditions that are clinically encountered. Currently, the vast majority of MP isolates are resistant to macrolides in East Asia, especially China, whereas in Europe and North America, whereas in Europe and North America prevalence is substantially lower than in Asia, varying across countries. The severity of pneumonia and extrapulmonary presentations may reflect the intensity of the host\'s immune reaction or the dissemination of bacterial infection. Children infected with
macrolide-resistant MP strains who receive
macrolide treatment experience persistent fever with extended antibiotic therapy and minimal decrease in MP-DNA load. Alternative second-line agents such as tetracyclines (doxycycline or minocycline) and fluoroquinolones (ciprofloxacin or levofloxacin) may lead to clinical improvement after macrolide treatment failure in children. Refractory MP pneumonia reflects a deterioration of clinical and radiological findings due to excessive immune response against the infection. Immunomodulators such as corticosteroids and intravenous immunoglobulin (IVIG) have shown promising results in treatment of refractory MP pneumonia, particularly when combined with appropriate antimicrobials. Corticosteroid-resistant hyperinflammatory MP pneumonia represents a persistent or recrudescent fever despite corticosteroid therapy with intravenous methylprednisolone at standard dosage.
CONCLUSIONS: This report summarizes the clinical significance of
macrolide-resistant and refractory MP pneumonia and discusses the efficacy and safety of alternative drugs, with a stepwise approach to the management of MP pneumonia recommended from the viewpoint of clinical practice.
BACKGROUND: • Although MP pneumonia is usually a benign self-limited infection with response macrolides as first line therapy, severe life-threatening cases may develop if additional treatment strategies are not effectively implemented. • Macrolide-resistant and refractory MP pneumonia are two conditions that may complicate the clinical course of MP pneumonia, increasing the risk for exacerbation and even death.
BACKGROUND: • This report summarizes the clinical relevance of macrolide-resistant and refractory MP pneumonia and discusses the efficacy and safety of alternative drug therapies. • A practical stepwise approach to the management of MP pneumonia is developed based on a comprehensive analysis of existing evidence and expert opinion.