莫西沙星治疗儿童重症肺炎支原体肺炎的安全性和有效性分析

Analysis of the safety and efficacy of moxifloxacin in the treatment of severe Mycoplasma pneumoniae pneumonia in children

目的评价儿童应用莫西沙星治疗重症肺炎支原体肺炎的安全性与有效性。方法回顾性分析2017年1月至2020年4月,北京儿童医院重症医学科应用莫西沙星治疗重症肺炎支原体肺炎的患儿。收集临床资料,判定临床疗效,分析用药安全性,总结肺炎支原体对大环内酯类抗生素耐药基因突变情况。结果39例重症肺炎支原体肺炎患儿应用莫西沙星治疗,大环内酯类抗生素耐药基因检测阳性率为95.2%。39例患儿中痊愈6例(15.4%),显效29例(74.4%),无效2例(5.1%),自动出院2例(5.1%),有效率为89.8%。用药期间密切观察患儿神志、皮肤、关节、心律和胃肠道功能等,密切监测血常规、肝肾功能,未发生与莫西沙星相关的短期药物不良反应。无患儿因不良反应而中止治疗。结论重症肺炎支原体肺炎患儿应用莫西沙星治疗有效性高,预后改善,短期观察并未发现与药物相关的不良反应,说明短期使用是安全的。儿童应用喹诺酮类药物为超说明书用药,临床药师应协助医师做好相关工作,降低医疗风险。

Objective To investigate the safety and efficacy of moxifloxacin in children with severe Mycoplasma pneumoniae pneumonia(SMPP).Methods The patients with SMPP in the Pediatric Intensive Care Unit of Beijing Children's Hospital between January 2017 and April 2020 were retrospectively analyzed.Clinical data were collected to assess therapeutic effi cacy,analyze drug safety and summarize positive rate of macrolide-resistant Mycoplasma pneumoniae genes mutation.Results Thirtynine children diagnosed SMPP treated with moxifl oxacin were included.The positive rate of macrolideresistant Mycoplasma pneumoniaegenes mutation was 95.2%.In the 39 patients,6(15.4%)were cured,29(74.4%)were effective,2(5.1%)were no response,2(5.1%)were discharged automatically during treatment with moxifl oxacin,and the overall response rate was 89.8%.The situations of consciousness,skin,joint,heart rhythm and gastrointestinal function were carefully observed;Blood routine test,liver and kidney function were closely monitored.There were no adverse drug reactions in the period of medication.No children were discontinued due to adverse reactions.Conclusions Moxifl oxacin can improve effi cacy and prognosis for pediatric patients with SMPP.There are no drug adverse reactions during treatment with moxifloxacin,indicating that short-term medication is safe.The application of quinolones in pediatric patients is off-label drug use,and clinical pharmacists should assist clinicians in reducing medical risks.