Traditional Chinese Medicine Oral Liquids Combined With Azithromycin for Mycoplasma pneumoniae Pneumonia in Children: A Bayesian Network Meta-Analysis

Abstract

Background:Mycoplasma pneumoniae pneumonia (MPP) causes flu-like symptoms in children, increasing the burden on the health and education systems. In China, traditional Chinese medicine oral liquids (TCMOLs) combined with azithromycin (TCMOLs + Azithromycin) is commonly used to treat MPP in children. However, TCMOLs with the optimal clinical applicability remain unknown. Here, we evaluated the clinical effectiveness and safety of TCMOLs + Azithromycin in children with MPP.Methods: We searched PubMed, Embase, Cochrane Library, Ovid, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP information resource integration service platform databases for eligible randomized controlled trials (RCTs) published from database inception to October 2020. Two reviewers independently performed data extraction and risk of bias assessment. After Bayesian random effect modeling and surface under the cumulative ranking curve (SUCRA) scoring, we ranked each intervention. We assessed heterogeneity using multivariate meta-regression for potential modifiers and used the Grading of Recommendations, Assessment, Development, and Evaluation to rate pooled evidence’s certainty.Results: In the 63 included RCTs with 6,410 children, five different TCMOLs were combined with azithromycin. TCMOLs + Azithromycin had significantly better primary outcomes than did azithromycin alone. Of all TCMOLs, Xiaoer Xiaoji Zhike (XEXJZK)+Azithromycin showed the best effectiveness with respect to the response rate (odds ratio [OR] = 6.5, 95% credible interval [CrI] = 4.3–10; low certainty) and pulmonary rales disappearance time (mean difference [MD] = −2.1, 95% CrI: −2.9 to −1.2; low certainty) with SUCRA 85 and 80%, respectively. Pudilan Xiaoyan + Azithromycin showed the highest effectiveness with respect to cough disappearance time (MD = −2.6, 95% CrI: −3.4 to −1.7; very low certainty) and fever disappearance time (MD = −1.8, 95% CrI: −2.3 to −1.3; very low certainty) with SUCRA 87 and 87%, respectively. The difference in the adverse effects between TCMOLs + Azithromycin and azithromycin alone was nonsignificant.Conclusion: Of the different TCMOLs, XEXJZK may be the best option to combine with azithromycin to treat children with MPP. However, our results should be interpreted with caution due to the low certainty of evidence. In general, TCMOLs’ safety remains unclear because of a lack of evidence. More high-quality RCTs are needed to further evaluate efficacy and safety of these TCMOLs.

Clinical significance of serum microRNA-146a and inflammatory factors in children with Mycoplasma pneumoniae pneumonia after azithromycin treatment

“… 14 While MPP is generally benign and mild, severe or prolonged infections can lead to extrapulmonary manifestations, affecting systems such as the digestive, cardiovascular, and nervous systems. 15 The host-pathogen interactions play a significant role in signaling and physiological changes within host cells and can induce post-transcriptional regulation of genes involved in immune and inflammatory responses, and the regulation of microRNAs (miRNAs) is closely related to infectious diseases. 16 Macrolide antibiotics, particularly azithromycin, are commonly used as the first-line treatment for MPP in clinical practice.…”

Azithromycin sequential therapy plus inhaled terbutaline for Mycoplasma Pneumoniae pneumonia in children: a systematic review and meta-analysis

“…even recruited patients regardless of the disease intensity. Secondly, the included interventions for MPP were not strict because extra medications such as acupuncture or special nursing were used in some studies [ 28 , 30 ]. Thirdly, an observational study with controls, in which the patients were grouped by therapy regimens [ 27 ], could not be identified as an RCT, because it is highly likely that this was a retrospective analysis of clinical cases.…”

Efficacy and Safety of Integrated Maxing Shigan Decoction and Azithromycin for Mycoplasma Pneumoniae Pneumonia in Children: A Systematic Review and Meta-Analysis

“…Importantly, the combination of TCMs with azithromycin was demonstrated to be more efective in the treatment of pediatric MPP. Although some studies lack sufcient evidence for higher safety, most meta-analytic studies suggested that TCMs combined with azithromycin have better clinical efcacy and fewer side efects in the treatment of MPP among children [69][70][71][72][73]. In China, MSD was commonly used in the clinical treatment of upper respiratory tract infections, pneumonia, and bronchial asthma, and accumulating studies revealed that MSD or MSD with western medicine also showed positive therapeutic benefts on MPP in children [15,74].…”

“…For MPP in children, TCMs are generally efective in relieving cough, fever, and pulmonary rales. Tis is refected in many oral liquids [72], Chinese herb injections [71] investigations, including liquiritin, glycyrrhizin, glycyrrhetinic acid, amygdalin, sagoside, ephedrine, pseudoephedrine, and methylephedrine [75]. Interestingly, a recent study found that MSD mitigates MPP-induced pyroptosis via the NLRP3 infammasome [15].…”