| 摘要: |
| 目的:探讨多西环素和阿奇霉素不同方案治疗大环内酯类耐药基因检测阳性的儿童肺炎支原体肺炎(MPP)的疗效及安
全性。方法:回顾性分析大环内酯类耐药基因阳性MPP 患儿的诊疗过程,按照初始阿奇霉素疗效及药物调整情况分组,初始治
疗有效者继续阿奇霉素静脉治疗(AZM1 组)或基于耐药基因结果换多西环素口服(DOX1 组),无效者维持原方案(AZM2 组)或
换多西环素口服(DOX2 组)。比较AZM1 组和DOX1 组、AZM2 组和DOX2 组的临床转归、联合治疗情况及药物不良反应。
结果:262 例MPP 检测出大环内酯类耐药基因位点均为23S rRNA: A2063G。AZM1 组和DOX1 组在临床转归、需联合治疗(联
合糖皮质激素/ 联合其他抗菌药物/ 支气管镜介入)方面比较差异无统计学意义,DOX2 组较AZM2 组住院时间短、热程短、胸部
影像学转归更优、需联合治疗的比例低,两种药物不良反应比较差异无统计学意义。结论:对于初始治疗失败的MPP,耐药基
因检测有助于抗菌药物的合理选用,及时调整为多西环素可改善临床转归、降低重症风险并避免过度治疗,且安全性高;临床应
严格把控多西环素使用指征,其使用需评估临床症状、动态观察疗效等综合判断,而非仅依赖基因检测结果。 |
| 关键词: 肺炎支原体 肺炎 大环内酯类耐药基因 多西环素 儿童 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2026.01.006 |
|
| 基金项目:南京医科大学科技发展基金项目,编号NMUB20240024 |
|
| Clinical Research on the Treatment of Mycoplasma Pneumoniae Pneumonia in Children with Positive DrugResistance Genes |
| Wang Wei, Wang Jin, Ge Lei |
| (The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, China) |
| Abstract: |
| Objective: To explore the efficacy and safety of different regimens of doxycycline and azithromycin in the treatment of
macrolide-resistant gene-positive Mycoplasma pneumoniae pneumonia (MPP) in children. Methods: A retrospective analysis was
performed on the diagnosis and treatment process of MPP children with positive macrolide-resistant genes. Patients were grouped
according to the efficacy of initial azithromycin treatment and subsequent drug adjustments: those with effective initial treatment with high safety. In clinical practice, the indications for doxycycline use should be strictly controlled. Its administration must be based
on comprehensive judgments such as assessment of clinical symptoms and dynamic observation of therapeutic efficacy, rather than relying
solely on genetic testing results.
continued intravenous azithromycin (AZM1 group) or switched to oral doxycycline based on resistance gene results (DOX1 group);
those with ineffective initial treatment either maintained the original regimen (AZM2 group) or switched to oral doxycycline (DOX2
group). The clinical outcomes, combined treatment, and adverse drug reactions were compared between AZM1 group and DOX1 group,
as well as AZM2 group and DOX2 group. Results: Results of detecting the macrolide-resistant gene loci in 262 children with MPP
showed that all of them had the 23S rRNA: A2063G gene locus. There were no statistically significant differences in clinical outcomes or
the need for combined treatment (combined with glucocorticoids/ other antibiotics/ bronchoscopic intervention) between the AZM1 group
and DOX1 group. Compared with the AZM2 group, the DOX2 group had shorter length of hospital stay, shorter fever duration, better
chest imaging outcomes, and lower rate of combined treatment. No significant differences in adverse drug reactions were observed
between two drugs. Conclusion: For MPP with initial treatment failure, detection of drug resistance genes facilitates rational selection of
antibiotics. Timely adjustment to doxycycline can improve clinical outcomes, reduce the risk of severe disease, and avoid over treatment |
| Key words: Mycoplasma pneumoniae pneumonia macrolide resistance gene doxycycline children |
