BACKGROUND Mycoplasma pneumoniae is one of the most common pathogens causing community acquired pneumonia in children. Although the rate of macrolide-refractory Mycoplasma pneumoniae (MRMP) has increased, systemic glucocorticoids as a treatment option has not been validated yet. The purpose of this study was to assess the efficacy of glucocorticoids add-on in the treatment of MRMP in children through systematic review and meta-analysis. METHODS Data sources A systematic literature search was conducted using ten electronic bibliographic databases including English, Korean, Chinese and Japanese languages, up to March 8, 2018. Study selection The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and selected randomized control trials which compared the efficacy of glucocorticoids add-on to macrolide in the treatment of MRMP in children. Data extraction Two independent reviewers extracted: primary outcomes as hospital days, fever duration, and change in C-reactive protein (CRP) and main analysis was performed through meta-analysis with random effects model. RESULTS Twenty-four unique randomized controlled trials met the inclusion criteria. The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in conventional macrolide-treatment group (Weighted mean difference (WMD) = - 4.03 days). The mean length of fever duration was significantly shorter in the glucocorticoid treatment group in comparison with the conventional treatment group (WMD = -3.32 days). Level of CRP after treatment was significantly lower in the glucocorticoid treatment group than that in the conventional treatment group (WMD = -16.03). Sensitivity analysis and subgroup analysis showed no significant improvement in heterogeneity. As limitations of the study, most of the studies included were from a single country and we were unable to control for heterogeneity across interventions, lack of standardized measures, and different time points of assessments across studies. CONCLUSIONS Glucocorticoid add-on treatment for MRMP can significantly shorten the duration of fever and hospital stay and decrease the level of CRP. These results should be confirmed by adequately powered studies in the future.

中文翻译：

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糖皮质激素治疗儿童大环内酯类难治性支原体肺炎的疗效：随机对照试验的荟萃分析。

背景技术肺炎支原体是引起儿童社区获得性肺炎的最常见病原体之一。尽管大环内酯类难治性肺炎支原体（MRMP）的发病率有所增加，但全身性糖皮质激素作为一种治疗选择尚未得到证实。这项研究的目的是通过系统评价和荟萃分析，评估糖皮质激素类药物在儿童MRMP治疗中的疗效。方法数据来源截至2018年3月8日，使用十个电子书目数据库（包括英语，韩语，中文和日语）进行了系统的文献检索。研究选择本研究是根据系统评价的首选报告项目和荟萃分析清单进行的，并选择了随机对照试验，比较了糖皮质激素与大环内酯类药物在儿童MRMP治疗中的疗效。数据提取两名独立的审查者提取：主要结局为住院天数，发烧持续时间和C反应蛋白（CRP）的变化，主要分析通过带有随机效应模型的荟萃分析进行。结果24项独特的随机对照试验符合纳入标准。糖皮质激素治疗组的平均住院时间明显短于传统的大环内酯类药物治疗组（加权平均差（WMD）=-4.03天）。与常规治疗组相比，糖皮质激素治疗组的平均发烧时间明显缩短（WMD = -3.32天）。糖皮质激素治疗组的治疗后CRP水平明显低于常规治疗组（WMD = -16.03）。敏感性分析和亚组分析显示异质性没有显着改善。由于研究的局限性，其中包括的大多数研究都来自单个国家，我们无法控制干预措施之间的异质性，缺乏标准化的措施以及研究之间评估的不同时间点。结论糖皮质激素联合治疗MRMP可显着缩短发烧时间和住院时间，并降低CRP水平。