Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in children

Abstract

Mycoplasma pneumoniae pneumonia (MP) is responsible for 10-40% of cases of pediatric community-acquired pneumonia. Occasionally, progression to severe pneumonia occurs despite appropriate antibiotic therapy. We retrospectively evaluated the effect of prednisolone in 15 children with MP whose clinical and radiographic course worsened despite broad-spectrum antibiotics, including appropriate macrolides. The mean ( +/- SD) age was 6.1 +/- 1.9 years, and 10 were boys. All children had received macrolides at presentation, but they had persistent fever and progressively worsening radiographic findings. In addition to broad-spectrum antimicrobial therapy, we added prednisolone (1 mg/kg for 3-7 days, then tapered over 7 days) on day 6 (+/-1.5 days) of admission. Fourteen children became afebrile within 24 hr, and their clinical status and radiographic findings improved over several days. The white blood cell count at presentation was 7,500 +/- 2,000/mm3, with a proportion demonstrating lymphopenia (lymphocyte differential, 19.7 +/- 5.7%). In conclusion, corticosteroid treatment appeared to be temporally associated with clinical and radiographic improvement, and may be helpful for reducing morbidity in children with macrolide-nonresponsive severe MP. Further studies may be warranted.

Lactate Dehydrogenase as a Biomarker for Prediction of RefractoryMycoplasma pneumoniaePneumonia in Children

“…22,23 Clinically and experimentally, steroids have a positive effect on refractory M. pneumoniae pneumonia. 2,4,16,24 However, steroids are usually initiated after the condition deteriorates. Thus, those with unrecoverable damage due to refractory M. pneumoniae pneumonia cannot rehabilitate completely.…”

“…First, we divided our subjects into 2 groups based on the definition of refractory M. pneumoniae pneumonia, 2,16 and this definition was broad. Therefore, spectrum bias was introduced into our results.…”

“…Refractory M. pneumoniae pneumonia is defined as a case with prolonged fever accompanied by deterioration of radiological findings despite appropriate management with macrolide treatment for Ն 7 d. 2,15,16 On the basis of this definition, we reviewed subjects' records and divided them into 2 groups: a refractory M. pneumoniae pneumonia group and a usual M. pneumoniae pneumonia group.…”

“…1 Although pneumonia due to M. pneumoniae is usually a benign, self-limited disease, some cases become refractory or severe and life-threatening. [2][3][4] It can also cause a wide array of extrapulmonary manifestations [5][6][7][8][9] and even lead to sequelae and disability, such as bronchi-ectasis, bronchiolitis obliterans, interstitial pulmonary fibrosis, and paralysis. 10,11 Clinically, corticosteroids have been used for refractory M. pneumoniae pneumonia and have a dramatic beneficial effect in both children and adults.…”

“…10,11 Clinically, corticosteroids have been used for refractory M. pneumoniae pneumonia and have a dramatic beneficial effect in both children and adults. 2,4,12 Clinicians must be cognizant of children with M. pneumoniae pneumonia at risk for developing refractory or serious illnesses and initiate steroid therapy in a timely fashion. Thus, it is desirable to predict refractory illness as soon as possible.…”