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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 effect of minocycline on Mycoplasma pneumoniae (MP) and to observe the effect of azithromycin-minocycline conversion therapy on Mycoplasma pneumoniae pneumonia (MPP). Methods The minimum inhibitory concentration (MIC) of minocycline to MP was determined by in vitro susceptibility test. The clinical observation program was designed according to the drug susceptibility test results. Select December 2008 -2009 December in Beijing Capital Medical University, Beijing Friendship Hospital pediatric hospital 60 cases of MPP. Randomly divided into treatment group and control group, the initial intravenous azithromycin 10 mg.kg-1.d-1, once every 3 d, the treatment group conversion oral minocycline 50 mg, every 12 h, until the fever Symptoms disappear 24 ~ 48 h; the control group was given oral azithromycin 10 mg.kg-1.d-1,1 times .d-1, intravenous and oral for a total of 7 ~ 10 d for a course of treatment, according to the disease needs repeated treatment . The differences of fever, hospitalization time, extrapulmonary complications and clinical efficacy between the two groups were observed. Results The minimum inhibitory concentration of minocycline against MP standard strain was 0.1 mg.L-1 and the minimum inhibitory concentration against macrolide-resistant drug strain was 0.025-1.000 mg.L-1. Children’s sex, age and pre-hospital course were comparable. The fever time (P = 0.000) and hospital stay (P = 0.002) in the treatment group were shorter than those in the control group, and the difference was statistically significant. The complication occurred in the treatment group Rate lower than the control group, high efficiency, but the difference was not statistically significant (P = 0.196,0.605). Conclusion Minocycline has a good inhibitory effect on MP. Using azithromycin-minocycline conversion therapy for MPP in children over 8 years can shorten the fever and hospital stay.