Treatment modalities for fever duration in children with Mycoplasma pneumoniae pneumonia

Categories: Disease & Virus

April 28, 2025

The clinical characteristics were compared between the treatment groups (Table 1). The median age ranged from 7.1 to 8.3 years, and the prevalence of UMCs ranged from 1.4 to 8.8%, with no statistically significant differences among these groups. The proportion of hospitalized patients and the length of hospital stay were significantly greater in the ML-O group, at 93.9% and 5.0 days (IQR, 4.0–6.0), respectively, than in the other groups (P = 0.023 and < 0.001, respectively). The rates of lobular or greater consolidation and PE were also significantly greater in the ML-O group, at 65.5% and 33.1%, respectively. The MR rate was also significantly greater in the ML-O (96.7%) and 2nd-A/S (100%) groups than in the ML group (72.0%) (P = 0.011). However, cases requiring intensive care unit (ICU) admission and cases with necrotizing pneumonia were extremely rare, within 2% and 1%, respectively, across all treatment groups, with no significant differences among the four groups.

Differences in fever duration by treatment group

In the SR group, the total duration of fever was 5.0 days (IQR, 4.0–7.0 days). Among the treatment groups, both the ML group and the 2nd-A/S group had a fever duration of 7.0 days (IQR, 5.0–9.0 days), and the ML-O group had a fever duration of 8.0 days (IQR, 6.0–10.0 days) (Table 1). Within the 2nd-A/S group, the 2nd-A ± S group had a fever duration of 7.0 days (IQR, 5.0–10.0 days), and the SD group had a fever duration of 6.0 days (IQR, 4.0–7.0 days) (Fig. 2). The time from the onset of fever to the use of macrolides was 5.0 days in both the ML and ML-O groups (IQR, 3.8–6.0 days and 3.0–6.0 days, respectively), and the time from the start of macrolide therapy to defervescence was 2.0 days (IQR, 1.0–3.0 days) and 3.0 days (IQR, 2.0–5.0 days), respectively (Fig. 2). In the ML-O, 2nd A ± S, and SD groups, the time from the onset of fever to the initial use of a second-line antibiotic or steroid was 6.0 days (IQR, 5.0–8.0 days, 4.0–7.0 days, and 4.0–7.0 days, respectively), and the time from the start of these agents to defervescence was 1.0 days (IQR, 0–2.0 days), 2.0 days (IQR, 1.0–3.0 days), and 0 days (IQR, 0–0 days), respectively (Fig. 2).

To account for the influence of the initial severity of MPP on clinicians’ choice of treatment, we compared the clinical characteristics only among patients with severe disease (Supplementary Table S1). The MR rate was significantly lower in the ML group (75.0%) than in the ML-O and 2nd-A/S groups (both 100%). Additionally, the durations of hospitalization and fever were significantly longer in the ML-O group, at 5.0 days (IQR 4.0–7.0) and 8.0 days (IQR 6.0–10.0), respectively, than in the ML group (4.0 and 7.0 days, respectively) and the 2nd-A/S group (4.0 and 6.0 days, respectively).

Effect of second-line antibiotics on defervescence

To directly assess the effects of second-line antibiotics on defervescence, we compared the ML group (n = 70) with the ML + 2nd-A group (n = 18) (Table 2 and Supplementary Table S2). There was a significant difference in the total duration of fever, with the ML group having 7.0 days (IQR 5.0–9.0) and the ML + 2nd-A group having 10.0 days (IQR, 8.0–13.0) (P = 0.001), which was attributed to the difference in the time from ML use to defervescence (2.0 days vs. 4.0 days). In the comparison between the ML + steroid group (n = 99) and the ML + steroid + 2nd -A group (n = 31), the hospitalization duration, total fever duration, time from ML use to defervescence, and time from the use of second-line treatment to defervescence were significantly longer in the group that received additional second-line antibiotics (P < 0.001 for all). Finally, in the comparison between the SD group (n = 55) and the 2nd-A&S group (n = 11), although there was no significant difference in the total duration of fever between the two groups, the hospitalization duration (6.0 days vs. 3.0 days, P < 0.001) and the time from the use of treatment to defervescence (3.0 days vs. 0 days, P < 0.001) were significantly longer in the 2nd-A&S group.

Table 2 Effectiveness of second-line antibiotics and steroids for treating fever in patients with Mycoplasma pneumoniae pneumonia.

Effect of steroids on defervescence

Compared with the ML group (n = 70) and the ML + steroid group (n = 99), the group treated with steroids had significantly greater rates of hospitalization (96.0% vs. 81.4%, P = 0.003), PE (35.4% vs. 12.9%, P = 0.001), high fever (82.8% vs. 68.6%, P = 0.030), and severe MPP (69.7% vs. 52.9%, P = 0.026). However, there were no significant differences in total hospitalization duration, total fever duration, or time from macrolide use to defervescence. In the comparison between the ML + 2nd -A group (n = 18) and the ML + 2nd -A&S group (n = 31), the periods from the onset of fever to the initiation of macrolide therapy (6.0 days vs. 4.0 days, P = 0.031) and second-line antibiotics (8.0 days vs. 6.0 days, P = 0.032) were longer in the group not receiving steroids, but there were no significant differences in total fever duration or duration from the use of macrolides or other antibiotics to defervescence between the two groups. Finally, the only significant difference between the 2nd-A group (n = 20) and the 2nd-A&S group (n = 11) was found in the total hospitalization duration (4.0 days vs. 6.0 days, P = 0.007). There were no significant differences in the other factors, including fever duration (Table 2 and Supplementary Table S3).