Xiao’ er Chiqiao Qingre Granule combined with azithromycin for treatment of Mycoplasma pneumoniae pneumonia in children: A systematic review and meta analysis of randomized controlled trials

IF 1.9 4区医学 Q3 INTEGRATIVE & COMPLEMENTARY MEDICINE

European Journal of Integrative Medicine Pub Date : 2025-05-27 DOI:10.1016/j.eujim.2025.102503

Shuo Yang , Xinying Liu , Yaowei Han , Dan Sun , Huanmin Li , Huizhe Wang , Ziyu Wang , Haokai Wang , Yunzheng Mei , Kunya Fu , Xinmin Li

{"title":"Xiao’ er Chiqiao Qingre Granule combined with azithromycin for treatment of Mycoplasma pneumoniae pneumonia in children: A systematic review and meta analysis of randomized controlled trials","authors":"Shuo Yang , Xinying Liu , Yaowei Han , Dan Sun , Huanmin Li , Huizhe Wang , Ziyu Wang , Haokai Wang , Yunzheng Mei , Kunya Fu , Xinmin Li","doi":"10.1016/j.eujim.2025.102503","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>In Asia, the incidence of <em>Mycoplasma pneumoniae</em> pneumonia is high and continues to rise. Xiao’ er Chiqiao Qingre Granules (XECQQR) consist of various Chinese medicinals and exhibit broad-spectrum antibacterial activity. This review conducts a systematic review and meta-analysis to evaluate the effectiveness of combining XECQQR with azithromycin in the treatment of MPP.</div></div><div><h3>Methods</h3><div>As of February 21, 2025, a comprehensive search across nine databases was conducted, including CNKI, PubMed and others, to identify randomized controlled trials (RCTs) evaluating XECQQR combined with azithromycin. Data were analyzed using Stata 14.0 and RevMan 5.4. The sources of evidence heterogeneity were explained by meta-regression and subgroup analysis. Methodological quality was assessed using the Cochrane Risk of Bias tool (ROB), and the certainty of evidence was graded via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</div></div><div><h3>Results</h3><div>A total of 26 RCTs involving 2626 patients were included. The combination of XECQQR and azithromycin was more effective than azithromycin alone, demonstrating higher efficacy rates and shorter times for the resolution of clinical symptoms and pulmonary signs. The combination therapy group exhibited significant reductions in response rate (RR = 1.17, 95 % CI [1.14, 1.21], low certainty evidence), disappearance time of fever (MD = -1.73 days, 95 % CI [-2.02, -1.44], very low certainty evidence), disappearance time of cough (MD = -2.65 days, 95 % CI [-3.08, -2.22], very low certainty evidence), and disappearance time of pulmonary rales (MD = -2.51 days, 95 % CI [-3.00, -2.02], very low certainty evidence). The combination therapy of XECQQR plus azithromycin demonstrated a significantly lower overall adverse event rate of 8.01 % (72/899) compared to 13.94 % (125/896) in the azithromycin monotherapy group (RR = 0.57, 95 % CI [0.44, 0.75], low certainty evidence).</div></div><div><h3>Conclusions</h3><div>Treatment with XECQQR combined with azithromycin may outperform azithromycin alone in alleviating clinical symptoms, pulmonary signs, reducing inflammatory response, and enhancing immune function. Furthermore, the combination therapy regimen demonstrates a favorable safety profile. Nevertheless, we anticipate the conduction of high-quality, large-scale, multicenter RCTs for confirmation and validation in the future.</div></div><div><h3>Review Registration</h3><div>PROSPERO CRD42023465734.</div></div>","PeriodicalId":11932,"journal":{"name":"European Journal of Integrative Medicine","volume":"77 ","pages":"Article 102503"},"PeriodicalIF":1.9000,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Integrative Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1876382025000551","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INTEGRATIVE & COMPLEMENTARY MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

In Asia, the incidence of Mycoplasma pneumoniae pneumonia is high and continues to rise. Xiao’ er Chiqiao Qingre Granules (XECQQR) consist of various Chinese medicinals and exhibit broad-spectrum antibacterial activity. This review conducts a systematic review and meta-analysis to evaluate the effectiveness of combining XECQQR with azithromycin in the treatment of MPP.

Methods

As of February 21, 2025, a comprehensive search across nine databases was conducted, including CNKI, PubMed and others, to identify randomized controlled trials (RCTs) evaluating XECQQR combined with azithromycin. Data were analyzed using Stata 14.0 and RevMan 5.4. The sources of evidence heterogeneity were explained by meta-regression and subgroup analysis. Methodological quality was assessed using the Cochrane Risk of Bias tool (ROB), and the certainty of evidence was graded via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results

A total of 26 RCTs involving 2626 patients were included. The combination of XECQQR and azithromycin was more effective than azithromycin alone, demonstrating higher efficacy rates and shorter times for the resolution of clinical symptoms and pulmonary signs. The combination therapy group exhibited significant reductions in response rate (RR = 1.17, 95 % CI [1.14, 1.21], low certainty evidence), disappearance time of fever (MD = -1.73 days, 95 % CI [-2.02, -1.44], very low certainty evidence), disappearance time of cough (MD = -2.65 days, 95 % CI [-3.08, -2.22], very low certainty evidence), and disappearance time of pulmonary rales (MD = -2.51 days, 95 % CI [-3.00, -2.02], very low certainty evidence). The combination therapy of XECQQR plus azithromycin demonstrated a significantly lower overall adverse event rate of 8.01 % (72/899) compared to 13.94 % (125/896) in the azithromycin monotherapy group (RR = 0.57, 95 % CI [0.44, 0.75], low certainty evidence).

Conclusions

Treatment with XECQQR combined with azithromycin may outperform azithromycin alone in alleviating clinical symptoms, pulmonary signs, reducing inflammatory response, and enhancing immune function. Furthermore, the combination therapy regimen demonstrates a favorable safety profile. Nevertheless, we anticipate the conduction of high-quality, large-scale, multicenter RCTs for confirmation and validation in the future.

Review Registration

PROSPERO CRD42023465734.

Abstract Image

查看原文本刊更多论文

小儿赤翘清热颗粒联合阿奇霉素治疗儿童肺炎支原体肺炎：随机对照试验的系统评价和meta分析

在亚洲，肺炎支原体肺炎的发病率很高，而且还在继续上升。小儿赤桥清热颗粒（XECQQR）由多种中药组成，具有广谱抗菌活性。本综述通过系统回顾和荟萃分析来评价XECQQR联合阿奇霉素治疗MPP的有效性。方法于2025年2月21日，对包括中国知网（CNKI）、PubMed等在内的9个数据库进行综合检索，以确定评估XECQQR联合阿奇霉素的随机对照试验（RCTs）。采用Stata 14.0和RevMan 5.4对数据进行分析。证据异质性的来源通过meta回归和亚组分析进行解释。使用Cochrane偏倚风险工具（ROB）评估方法学质量，并通过建议评估、发展和评价分级（GRADE）框架对证据的确定性进行分级。结果共纳入26项随机对照试验，共纳入2626例患者。XECQQR联合阿奇霉素比单用阿奇霉素更有效，对临床症状和肺部体征的缓解有效率更高，时间更短。联合治疗组在缓解率（RR = 1.17, 95% CI[1.14, 1.21]，低确定性证据）、发热消失时间（MD = -1.73天，95% CI[-2.02, -1.44]，极低确定性证据）、咳嗽消失时间（MD = -2.65天，95% CI[-3.08, -2.22]，极低确定性证据）、肺部罗鸣消失时间（MD = -2.51天，95% CI[-3.00, -2.02]，极低确定性证据）均有显著降低。XECQQR联合阿奇霉素治疗组总不良事件发生率为8.01%(72/899)，明显低于阿奇霉素单药治疗组的13.94% (125/896)（RR = 0.57, 95% CI[0.44, 0.75]，低确定性证据）。结论XECQQR联合阿奇霉素治疗在缓解临床症状、肺部体征、降低炎症反应、增强免疫功能等方面优于阿奇霉素单用。此外，联合治疗方案显示出良好的安全性。然而，我们期待在未来进行高质量、大规模、多中心的随机对照试验来确认和验证。审核注册号prospero CRD42023465734。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Integrative Medicine INTEGRATIVE & COMPLEMENTARY MEDICINE-

CiteScore

4.70

自引率

4.00%

发文量

102

审稿时长

33 days

期刊介绍： The European Journal of Integrative Medicine (EuJIM) considers manuscripts from a wide range of complementary and integrative health care disciplines, with a particular focus on whole systems approaches, public health, self management and traditional medical systems. The journal strives to connect conventional medicine and evidence based complementary medicine. We encourage submissions reporting research with relevance for integrative clinical practice and interprofessional education. EuJIM aims to be of interest to both conventional and integrative audiences, including healthcare practitioners, researchers, health care organisations, educationalists, and all those who seek objective and critical information on integrative medicine. To achieve this aim EuJIM provides an innovative international and interdisciplinary platform linking researchers and clinicians. The journal focuses primarily on original research articles including systematic reviews, randomized controlled trials, other clinical studies, qualitative, observational and epidemiological studies. In addition we welcome short reviews, opinion articles and contributions relating to health services and policy, health economics and psychology.