title: Effects of methylprednisolone or immunoglobulin when added to standard treatment with intravenous azithromycin for refractory Mycoplasma pneumoniae pneumonia in children.
abstract: BACKGROUND
  The prevalence of Mycoplasma pneumoniae pneumonia has increased considerably in recent years. To evaluate the efficacy of combined treatment of azithromycin with intravenous immunoglo-bulin (IVIG) or methylprednisolone in children with refractory Mycoplasma pneumoniae pneumonia (RMPP).
  
  
  METHODS
  Children with RMPP were randomly allocated to group A [intravenous azithromycin (IA)+ methylprednisolone], group B (IA+IVIG) or group C (IA alone). Following a 7-day treatment, group C patients were randomly separated into two sub-groups: group C1(IA+methylprednisolone) and group C2(IA+IVIG). Temperature, respiratory symptoms and signs were examined. The average febrile period after treatment (F2), average total febrile period (F3), infiltration absorption, atelectasis resolution, pleural effusion disappearance were determined. The levels of C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) were measured.
  
  
  RESULTS
  Seven days after enrollment, the average F2after treatment of group A was the shortest. Compared with the control group C, the combined treatment group A and B showed higher rates of infiltration absorption, atelectasis resolution and pleural effusion disappearance, while lower levels of serum CRP, D-dimer and LDH. Fourteen days after enrollment, all children with combined therapy clinically improved, and presented better laboratory results. Group C1showed shorter F3and lower levels of CRP and LDH than those of group C2. Overall, group A showed the shortest F3, also has the lowest CRP and LDH.
  
  
  CONCLUSIONS
  Azithromycin with IVIG or methylprednisolone was better treatment for children with RMPP than azithromycin alone. IVIG treatment may be beneficial, especially when the efficacy of corticosteroids is insecure, thus could be considered as an alternative of primary therapeutic approaches.
authors.affiliation: Department of Pediatric Pulmonology, Shengjing Hospital of China Medical University, 36 Heping, Shenyang, 110004, China. shanls@sj-hospital.org.
authors.forename: Li-Shen
authors.initials: LS
authors.lastname: Shan
authors.affiliation: Department of Pediatric Pulmonology, Shengjing Hospital of China Medical University, 36 Heping, Shenyang, 110004, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.affiliation: China Medical University, Shenyang, China.
authors.forename: Xin-Yuan
authors.initials: XY
authors.lastname: Kang
authors.affiliation: Department of Pediatric Pulmonology, Shengjing Hospital of China Medical University, 36 Heping, Shenyang, 110004, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Pediatric Pulmonology, Shengjing Hospital of China Medical University, 36 Heping, Shenyang, 110004, China.
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Han
authors.affiliation: Department of Pediatric Pulmonology, Shengjing Hospital of China Medical University, 36 Heping, Shenyang, 110004, China.
authors.forename: Yun-Xiao
authors.initials: YX
authors.lastname: Shang
mesh_terms: D000704:Analysis of Variance; D017963:Azithromycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002681:China; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D009177:Mycoplasma pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D017963:Azithromycin; D008775:Methylprednisolone
keywords: immunoglobulin; methylprednisolone; refractory Mycoplasma pneumoniae pneumonia