阿奇霉素-米诺环素转换疗法治疗肺炎支原体肺炎的疗效

Efficacy of Azithromycin-Minocycline Switch Therapy on Mycoplasma pneumoniae Pneumonia

目的了解米诺环素对肺炎支原体(MP)的抑制作用,观察阿奇霉素-米诺环素转换疗法治疗肺炎支原体肺炎(MPP)的效果。方法应用体外药敏试验测定米诺环素对MP的最小抑菌浓度(MIC),根据药敏试验结果设计临床观察方案。选择2008年12月-2009年12月在首都医科大学附属北京友谊医院儿科住院MPP患儿60例。随机分为治疗组和对照组,初期均静脉滴注阿奇霉素10 mg.kg-1.d-1,连用3 d,治疗组转换口服米诺环素50 mg,每12 h 1次,持续至发热症状消失24～48 h;对照组序贯口服阿奇霉素10 mg.kg-1.d-1,1次.d-1,静脉及口服共7～10 d为1个疗程,可根据病情需要重复疗程。观察2组患儿在发热时间、住院时间、肺外并发症、临床疗效等方面的差异。结果米诺环素对MP标准株的最小抑菌质量浓度为0.1 mg.L-1,对耐大环内酯药物株的最小抑菌质量浓度为0.025～1.000 mg.L-1;2组患儿性别、年龄、住院前病程有可比性;治疗组患儿的发热时间(P=0.000)、住院时间(P=0.002)均短于对照组,且差异有统计学意义;治疗组并发症发生率较对照组低、有效率高,但差异无统计学意义(P=0.196,0.605)。结论米诺环素对MP有良好的抑制作用;应用阿奇霉素-米诺环素转换疗法治疗8岁以上儿童MPP可缩短发热时间、住院时间。

Objective To investigate the inhibitory activity of minocycline against Mycoplasma pneumonia （MP） and efficacy against MP pneumonia （MPP） of azithromycin - minocycline switch therapy. Methods In vitro drug susceptibility test was performed to determine minimum inhibitory concentration（ MIC ） of minocycline to MP. Thereafter,the clinical trial was designed according to the results of drug sus- ceptibility test. Sixty children confirmed to with MPP who presented to Pediatric Department of Beijing Friendship Hospital Affiliated to Caphal Medical University between Dec. 2008 and Dec. 2009 were assigned. They were randomly divided into treatment group and control group ; du- ring the initial stage all patients were treated with intravenous infusions of azithromycin 10 mg·kg^-1·d^-1 once daily for 3 days, then treatment group was converted to take oral minocycline 50 mg,every 12 h,until fever symptoms disappeared for 24 -48 h, while control group remained on azithromycin 10 mg·kg^-1·d^-1by oral,once a day. A total treatment course included intravenous infusion and oral lasting 7 - 10 days. Course of treatment could be repeated according to state of illness. Differences in fever period, hospital stay, pulmonary complications, and clinical efficacy of patients in the 2 groups were observed. Results MIC of minocycline against MP standard strains was 0.1 mg· L-1 ,while against drug - resistant strains was 0.025 - 1. 000 mg · L ^-1. Fever time （ P = 0. 000 ） and hospital stay （ P = 0. 002 ） of treatment group were shorter than those in control group. Treatment group tended to had less complication incidence and higher clinical efficacy than those in control group,while the differences were not significant （P = 0. 196,0. 605 ）. Conclusions Minocycline shows good inhibitory effect against MP; azithromycin- minocycline switch therapy can shorten fever time and hospital stay in children with MPP.