治疗对大环内酯类药物耐药的儿童肺炎支原体肺炎的其他疗法的益处和风险。

Korean Journal of Pediatrics Pub Date : 2019-06-01 Epub Date: 2019-03-15 DOI:10.3345/kjp.2018.07367
Hyeon-Jong Yang
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引用次数: 0

摘要

尽管肺炎支原体肺炎(MPP)对大环内酯类药物普遍易感,但耐大环内酯类药物的肺炎支原体肺炎(MRMP)的出现使其治疗面临挑战。2000 年代后,MRMP 迅速蔓延,尤其是在东亚。与成人相比,MRMP 在儿童和青少年中更为常见,这可能与频繁使用大环内酯类药物治疗儿童肺炎双球菌感染有关。MRMP不太可能与临床、实验室或放射学的严重程度有关,但它可能会延长症状的持续时间和住院时间。因此,MRMP 会增加疾病负担,降低患者的生活质量,并造成社会经济负担。迄今为止,MRMP 的唯一替代治疗方法是二类抗菌药物,如四环素类(TC)或氟喹诺酮类(FQ)或全身性皮质类固醇;然而,由于担心潜在的不良反应(如牙齿变色或肌腱病),前者在儿童中是禁用的。一些指南建议将 TCs 或 FQs 作为治疗 MRMP 的二线首选药物。然而,目前还没有以证据为基础的指南。此外,安全性问题也尚未解决。因此,本文旨在回顾治疗儿童 MRMP 的替代疗法的益处和风险,并回顾国际或地区指南的建议及其实际应用的具体注意事项。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Benefits and risks of therapeutic alternatives for macrolide resistant Mycoplasma pneumoniae pneumonia in children.

Although Mycoplasma pneumoniae pneumonia (MPP) has been generally susceptible to macrolides, the emergence of macrolide-resistant MPP (MRMP) has made its treatment challenging. MRMP rapidly spread after the 2000s, especially in East Asia. MRMP is more common in children and adolescents than in adults, which is likely related to the frequent use of macrolides for treating M. pneumoniae infections in children. MRMP is unlikely to be related to clinical, laboratory, or radiological severity, although it likely prolongs the persistence of symptoms and the length of hospital stay. Thereby, it causes an increased burden of the disease and poor quality of life for the patient as well as a societal socioeconomic burden. To date, the only alternative treatments for MRMP are secondary antimicrobials such as tetracyclines (TCs) or fluoroquinolones (FQs) or systemic corticosteroids; however, the former are contraindicated in children because of concerns about potential adverse events (i.e., tooth discoloration or tendinopathy). A few guidelines recommended TCs or FQs as the second-line drug of choice for treating MRMP. However, there have been no evidence-based guidelines. Furthermore, safety issues have not yet been resolved. Therefore, this article aimed to review the benefits and risks of therapeutic alternatives for treating MRMP in children and review the recommendations of international or regional guidelines and specific considerations for their practical application.

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来源期刊
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审稿时长
12 weeks
期刊介绍: Korean J Pediatr covers clinical and research works relevant to all aspects of child healthcare. The journal aims to serve pediatricians through the prompt publication of significant advances in any field of pediatrics and to rapidly disseminate recently updated knowledge to the public. Additionally, it will initiate dynamic, international, academic discussions concerning the major topics related to pediatrics. Manuscripts are categorized as review articles, original articles, and case reports. Areas of specific interest include: Growth and development, Neonatology, Pediatric neurology, Pediatric nephrology, Pediatric endocrinology, Pediatric cardiology, Pediatric allergy, Pediatric pulmonology, Pediatric infectious diseases, Pediatric immunology, Pediatric hemato-oncology, Pediatric gastroenterology, Nutrition, Human genetics, Metabolic diseases, Adolescence medicine, General pediatrics.
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