Treatment of Mycoplasma Pneumonia: A Systematic Review

Abstract

BACKGROUND AND OBJECTIVE: Children with community-acquired lower respiratory tract infection (CA-LRTI) commonly receive antibiotics for Mycoplasma pneumoniae. The objective was to evaluate the effect of treating M. pneumoniae in children with CA-LRTI.METHODS: PubMed, Cochrane Central Register of Controlled Trials, and bibliography review. A search was conducted by using Medical Subject Headings terms related to CA-LRTI and M. pneumoniae and was not restricted by language. Eligible studies included randomized controlled trials (RCTs) and observational studies of children #17 years old with confirmed M. pneumoniae and a diagnosis of CA-LRTI; each must have also compared treatment regimens with and without spectrum of activity against M. pneumoniae. Data extraction and quality assessment were completed independently by multiple reviewers before arriving at a consensus. Data were pooled using a random effects model. RESULTS:Sixteen articles detailing 17 studies were included. The most commonly selected primary outcome was symptomatic improvement. Nine studies examined M. pneumoniae treatment in CA-LRTI secondary to M. pneumoniae, and 5 RCTs met criteria for meta-analysis. The suggested pooled risk difference of 0.12 (95% confidence interval, 20.04 to 0.20) favoring treatment was not significantly different and demonstrated significant heterogeneity. Limitations included substantial bias and subjective outcomes within the individual studies, difficulty interpreting testing modalities, and the inability to correct for mixed infections or timing of intervention. CONCLUSIONS:We identified insufficient evidence to support or refute treatment of M. pneumoniae in CA-LRTI. These data highlight the need for well-designed, prospective RCTs assessing the effect of treating M. pneumoniae in CA-LRTI.

Antibiotic Prescribing Patterns Across the Continuum of Care for Children Hospitalized With Community-Acquired Pneumonia

“…A recent meta-analysis assessing the effect of treating M. pneumoniae in children diagnosed with laboratory-confirmed infection identified no clinically significant impact, suggesting that the empiric use of macrolide therapy in older children with CAP should be reassessed. 18 Our study has limitations. First, we relied upon retrospective identification of qualifying cases through a combination of automated and manual review of administrative data, which could have resulted in missing cases where data were inaccurate or incomplete.…”

Unusual Eruptions Associated with <b><i>Mycoplasma pneumoniae</i></b> Respiratory Infections: Review of the Literature

“…Recent data indicate that there is no clear evidence that antibiotic treatment of mycoplasmal pneumonia is effective [101]. …”

Cambiando los paradigmas de la infección por M. pneumoniae en pediatría

“…70 Una revisión sistemática de 17 estudios no encontró significancia estadística en el beneficio del uso de antibióticos en aquellos pacientes con infección respiratoria baja por M. pneumoniae. 71 De manera similar, en una revisión que involucró siete estudios con 1,912 niños con infección del tracto respiratorio inferior por M. pneumoniae, se analizó la respuesta clínica de pacientes tratados con esquemas de antibióticos basados en macró-lidos, comparada con esquemas que no incluían macrólidos, encontrándose que no había ninguna diferencia. 72 En contraparte, hay estudios que reflejan que pacientes con M. pneumoniae sensibles a macrólidos (MPSM), al ser tratados con los mismos, tienen una mejor evolución clínica y menor índice de complicaciones que aquellos pacientes con M. pneumoniae resistentes a macrólidos (MPRM).…”