中国临床药理学杂志

阿奇霉素与四环素类抗生素对儿童大环内酯类无反应性肺炎支原体肺炎的临床研究

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王健 ^a , 尹小梅 ^a , 刘媛媛 ^b , 杜燕燕 ^a , 宋琳 ^a , 李宁宁 ^a , 莫若 ^a , 贾胜男 ^a , 王月娇 ^a , 季丽娜 ^a , 徐樨巍 ^a

中国临床药理学杂志 | 临床与基础桥接研究 2025,41(22): 3151-3155

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中国临床药理学杂志 |临床与基础桥接研究 2025 , 41 (22) : 3151 -3155

阿奇霉素与四环素类抗生素对儿童大环内酯类无反应性肺炎支原体肺炎的临床研究

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王健^a, 尹小梅^a, 刘媛媛^b, 杜燕燕^a, 宋琳^a, 李宁宁^a, 莫若^a, 贾胜男^a, 王月娇^a, 季丽娜^a, 徐樨巍^a

作者信息

^a.清华大学北京清华长庚医院儿科，北京 102218

^b.清华大学北京清华长庚医院临床药学科，北京 102218

通讯作者:

尹小梅，副主任医师 Tel: （010）56111129 E-mail: yxma01138@btch.edu.cnyxma01138@btch.edu.cn

作者简介:

王健（1994-），男，主治医师，主要从事儿童常见疾病的临床工作和研究

Clinical trial on azithromycin versus tetracycline antibiotics for macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children

Jian WANG^a, Xiao-mei YIN^a, Yuan-yuan LIU^b, Yan-yan DU^a, Lin SONG^a, Ning-ning LI^a, Ruo MO^a, Sheng-nan JIA^a, Yue-jiao WANG^a, Li-na JI^a, Xi-wei XU^a

Affiliations

^a.Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China

^b.Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China

出版时间: 2025-11-28 doi: 10.13699/j.cnki.1001-6821.2025.22.001

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摘要

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目的

观察注射用阿奇霉素延续治疗与转换为四环素类抗生素（多西环素肠溶胶囊/米诺环素胶囊）对儿童大环内酯类无反应性肺炎支原体肺炎（MUMPP）的临床疗效和安全性。

方法

将本院住院的MUMPP患儿，根据大环内酯类初始治疗72 h无效后的二次抗生素选择分为试验组和对照组。对照组继续给予注射用阿奇霉素10 mg·kg^-1，qd，疗程7 d。试验组改为口服四环素类抗生素，米诺环素胶囊2 mg·kg^-1，bid，或多西环素肠溶胶囊2.2 mg·kg^-1，bid，总疗程10 d。比较2组患者的退热时间、治疗有效率、白细胞计数（WBC）、中性粒细胞百分比（NE%）、C反应蛋白（CRP）水平的变化，并进行安全性评价。

结果

本研究共纳入107例，试验组87例，对照组20例。试验组和对照组的临床总有效率分别为90.80%（79例/87例）和85.00%（17例/20例），在统计学上差异无统计学意义（P>0.05）。试验组和对照组的退热时间分别是（6.82±1.71）和（7.75±2.12）d，在统计学上差异有统计学意义（P<0.05）。在转换治疗前，对照组和试验组白细胞分别是（8.58±3.67）和（6.77±2.59）×10⁹·L^-1，CRP分别是（14.44±8.58）和（26.43±26.53）mg·L^-1，在统计学上差异均有统计学意义（均P<0.05）。对照组和试验组中性粒细胞百分比分别是（57.93±9.39）%和（62.43±10.79）%，淋巴细胞百分比分别是（32.43±8.46）%和（28.60±9.57）%，单核细胞百分比分别是（7.63±2.01）%和（7.43±2.53）%，在统计学上差异均无统计学意义（均P>0.05）。试验组和对照组的药物总不良反应发生率分别为1.15%和0，在统计学上差异无统计学意义（P>0.05）。

结论

对于MUMPP患儿，应用四环素类抗生素可更快缓解发热，但两种方案总体疗效相当。临床选择需综合患儿年龄（≥8岁优先考虑四环素类）及家长知情同意。阿奇霉素延续治疗时建议联用糖皮质激素控制过度炎症反应。

关键词

注射用阿奇霉素 / 四环素类抗生素 / 大环内酯类耐药 / 肺炎支原体肺炎 / 儿童

Abstract

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Objective

To evaluate the differences in clinical efficacy between continued azithromycin therapy and switching to tetracycline antibiotics (doxycycline/minocycline) in children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP).

Methods

Children with MUMPP hospitalized in our hospital were divided into treatment group and control group according to the secondary antibiotic selection after ineffective initial macrolide treatment for 72 hours. The control group continued to receive azithromycin for injection at a dose of 10 mg·kg^-1 once a day for a 7-day course of treatment. The treatment group was switched to oral tetracycline antibiotics: minocycline capsules at 2 mg·kg^-1 twice a day, or doxycycline enteric-coated capsules at 2.2 mg·kg^-1 twice a day, with a total course of 10 days. The time to defervescence, treatment effectiveness rate, and changes in white blood cell count (WBC), neutrophil percentage (NE%) and C-reactive protein (CRP) levels were compared between the two groups, and a safety evaluation was performed.

Results

A total of 107 cases were included in this study, with 87 cases in the treatment group and 20 cases in the control group. The total clinical effective rates of the treatment group and the control group were 90.80% (79 cases /87 cases) and 85.00% (17 cases /20 cases), respectively, and the difference was not statistically significant (P>0.05). The antipyretic time of the treatment group and the control group was (6.82±1.71) and (7.75±2.12) days, respectively, with statistically significant difference (P<0.05). Before conversion therapy, the white blood cell counts of the control group and the treatment group were (8.58±3.67) and (6.77±2.59) ×10⁹·L^-1, respectively, and the CRP levels were (14.44±8.58) and (26.43±26.53) mg·L^-1, respectively; both differences were statistically significant (all P<0.05). The neutrophil percentages of the control group and the treatment group were (57.93±9.39)% and (62.43±10.79)%, respectively, the lymphocyte percentages were (32.43±8.46)% and (28.60±9.57)%, respectively, the monocyte percentages were (7.63±2.01)% and (7.43±2.53)%, respectively, none of these differences were statistically significant (all P>0.05). The total incidence of adverse drug reactions in the treatment group and the control group was 1.15% and 0, respectively, with no statistically significant difference (P>0.05).

Conclusion

For children with MUMPP, tetracycline antibiotics provide faster fever resolution, but the overall efficacy of both regimens is comparable. Clinical decisions should consider the child’s age (tetracyclines preferred for those ≥8 years) and parental informed consent. Continued azithromycin therapy is recommended in combination with glucocorticoids to control excessive inflammatory responses.

Key words

azithromycin for injection / tetracycline antibiotics / macrolide resistance / Mycoplasma pneumoniae pneumonia / children

引用本文

王健, 尹小梅, 刘媛媛, 杜燕燕, 宋琳, 李宁宁, 莫若, 贾胜男, 王月娇, 季丽娜, 徐樨巍. 阿奇霉素与四环素类抗生素对儿童大环内酯类无反应性肺炎支原体肺炎的临床研究. 中国临床药理学杂志, 2025 , 41 (22) : 3151 -3155 . DOI: 10.13699/j.cnki.1001-6821.2025.22.001

Jian WANG, Xiao-mei YIN, Yuan-yuan LIU, Yan-yan DU, Lin SONG, Ning-ning LI, Ruo MO, Sheng-nan JIA, Yue-jiao WANG, Li-na JI, Xi-wei XU. Clinical trial on azithromycin versus tetracycline antibiotics for macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children[J]. Chinese Journal of Clinical Pharmacology, 2025 , 41 (22) : 3151 -3155 . DOI: 10.13699/j.cnki.1001-6821.2025.22.001

基金

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北京市卫生与健康科技成果和适宜技术推广基金资助项目(TG-2017-41)

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2025年第41卷第22期

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文章信息

doi: 10.13699/j.cnki.1001-6821.2025.22.001

接收时间：2025-08-04
首发时间：2026-08-05
出版时间：2025-11-28

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收稿日期：2025-08-04

基金

北京市卫生与健康科技成果和适宜技术推广基金资助项目(TG-2017-41)

作者信息

^a.清华大学北京清华长庚医院儿科，北京 102218

^b.清华大学北京清华长庚医院临床药学科，北京 102218

通讯作者:

尹小梅，副主任医师 Tel: （010）56111129 E-mail: yxma01138@btch.edu.cnyxma01138@btch.edu.cn

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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