Acetylcysteine and budesonide for the treatment of refractory Mycoplasma pneumoniae pneumonia in children: a clinical observation

Abstract

Background To examine the clinical impact of bronchoscope alveolar lavage (BAL) combination with budesonide, ambroxol + budesonide, or acetylcysteine + budesonide in the treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods Eighty-two RMPP patients admitted to Pediatrics at The First People's Hospital of Zhengzhou were retrospectively evaluated between August 2016 and August 2019. All patients were administered BAL in addition to intravenous Azithromycin, expectoration, and nebulizer inhalation. The medications added to the BLA separated the patients into the Budesonide group, Ambroxol+budesonide group, and acetylcysteine+budesonide group. Analyzed were the variations in laboratory examination indices, improvement in lung imaging, overall effective rate, and adverse responses in the three groups. Results The laboratory test indices of patients in all three groups improved significantly relative to pre-treatment levels, and the results were statistically significant. After therapy, there were no significant differences between the three groups in terms of white blood cell (WBC), C-reactive protein (CRP), or erythrocyte sedimentation rate (ESR). Serum lactate dehydrogenase (LDH) and serum ferritin (SF) varied significantly across the three groups (P0.05). In the acetylcysteine + budesonide group, the absorption rate of lung imaging lesions and clinical efficacy were superior to those of the other two groups. There were no significant differences between the three groups in the occurrence of adverse events (P>0.05). Conclusions BLA-coupled acetylcysteine+ budesonide was superior to the other two groups in enhancing the effectiveness of RMPP in children, which might increase lung opacity absorption and minimize lung inflammation.

Meta-analysis of combined azithromycin and inhaled budesonide treatment for Chinese pediatric patients with mycoplasma pneumonia

“…[41,42] In China, budesonide nebulize is one of the most regularly used medications for the lavage solution during bronchoscopic alveolar lavage, with fewer reports coming from other countries. [43] The objective of this study is to assess the effectiveness and safety of budesonide as an adjunctive therapy to azithromycin in the treatment of Mycoplasma pneumonia in Chinese pediatric patients, to offer a solid theoretical foundation for the clinical application of budesonide. Our findings indicate that the combination of budesonide with azithromycin for the treatment of pediatric Mycoplasma pneumonia delivers superior therapeutic efficacy, improved pulmonary function, reduced duration of fever, faster resolution of cough and rales, diminished lung inflammation, all without increasing the occurrence of adverse events.…”

“…Studies were incorporated into the analysis according to the following criteria in line with the PICOS framework: Participants: pediatric patients diagnosed with mycoplasma pneumonia; Interventions: inhaled budesonide in combination with azithromycin and azithromycin alone; Comparisons: assessing both efficacy and safety; Outcome measures: studies needed to report one or more of the following endpoints: total effective rate, adverse reactions, time for body temperature normalization, the time of disappearance of rales in the lungs, the time of disappearance of cough, pulmonary function, and inflammatory Jianbin et al [12] 2021 2018-2020 14 d 26 26 4.08 ± 1.47 4.52 ± 1.78 Intravenous Inhalation Naiju [13] 2021 2019-2020 14 d 30 30 6.60 ± 1.71 6.71 ± 1.80 Intravenous Inhalation Li and Yan [14] 2023 2021-2022 14 d 44 44 7.2 ± 1.4 6.7 ± 1.6 Intravenous Inhalation Hongbin [15] 2022 2020-2022 14 d 40 40 9.62 ± 1.34 9.95 ± 1.28 Intravenous Inhalation Zhou Yinhong [35] 2022 2019-2022 14 d 51 50 7.79 ± 2.12 7.84 ± 2.05 Intravenous Inhalation Xinyi [16] 2022 2020-2022 Not report 32 33 10.21 ± 3.36 9.68 ± 3.22 Intravenous Inhalation Linyun et al [17] 2023 2020-2022 7 d 31 31 7.00 ± 2.00 7.00 ± 2.33 Intravenous Inhalation Zhongzheng [18] 2022 [19] 2020 2017-2018 7 d 28 28 4.5 ± 1.4 4.8 ± 1.5 Intravenous Inhalation Xin et al [20] 2022 Not report 14 d 50 50 9.69 ± 2.77 9.32 ± 2.82 Intravenous Inhalation Wei et al [21] 2022 2018-2021 14 d 40 40 7.01 ± 1.48 6.92 ± 1.54 Intravenous Inhalation Di [22] 2022 2019-2020 10 d 41 41 4.6 ± 2.4 5.1 ± 2.0 Intravenous Inhalation Shangqing [23] 2022 2019-2020 14 d 43 43 3.04 ± 0.18 3.02 ± 0.21 Intravenous Inhalation Chunsun et al [24] 2020 2018-2019 7 d 48 48 6.84 ± 2.25 6.77 ± 2.10 Intravenous Inhalation Bo [25] 2022 [26] 2022 2016-2020 14-21 d 115 115 4.5 ± 1.1 6.5 ± 1.4 Intravenous Inhalation Jinglei et al [27] 2022 2018-2021 14 d 50 50 5.94 ± 0.85 5.96 ± 0.88 Intravenous Inhalation Li et al [28] 2023 2020-2021 10 d 100 100 4.72 ± 2.87 4.35 ± 2.28 Sequential Inhalation Zhishun and Yongchao [29] 2019 2017-2019 7 d 67 67 3.1 ± 0.7 3.4 ± 0.7 Sequential Inhalation Yanchun and Qiong [30] 2022 2020-2021 15 d 49 49 7.53 ± 1.19 7.29 ± 1.12 Sequential Inhalation Jianwei [31] 2022 2020-2021 21 d 34 34 7.98 ± 2.34 8.03 ± 2.37 Oral Inhalation Wenwen et al [32] 2023 2020-2022 7 d 60 60 5.08 ± 2.25 5.14 ± 2.23 Oral Inhalation Dali et al [...…”