Macrolide Benefit Unclear in Kids With Mycoplasma Pneumonia

Macrolide treatment of Mycoplasma pneumoniae may or may not benefit children with community-acquired lower respiratory tract infection (CA-LRTI), according to an article published in the June issue of Pediatrics.

Eric Biondi, MD, from the Department of Pediatrics, University of Rochester, New York, and colleagues conducted a systematic review and meta-analysis of published articles on observational and randomized trials comparing macrolide, tetracycline, or quinolone class antibiotics with spectrum of activity for M pneumonia with placebo or other antibiotics that lacked spectrum of activity for M pneumonia in children younger than 18 years who had CA-LRTI.

The researchers identified 17 trials involving 4294 patients. They identified 9 studies (723 patients) with enough detail to compare M pneumonia spectrum and nonspectrum treatment in children with CA-LRTI secondary to M pneumonia. Of those 9 trials, nearly all prospective studies found no clinical benefit, and for the ones that suggested a statistical decrease in fever duration, the decrease was "not necessarily clinically relevant," the researchers write.

They conducted a meta-analysis of 5 randomized controlled trials, and 4 of those studies did not find a benefit from M pneumonia treatment. The meta-analysis "suggests a small treatment benefit in patients with CA-LRTI secondary to M. pneumonia," the researchers write. However, they point out that the pooled effect favoring treatment resulted primarily from a single randomized trial that examined macrolide treatment effects and included children with upper respiratory tract infections.

"Our systematic review provides insufficient evidence to support conclusions about the efficacy of macrolide treatment of CA-LRTI due to M. pneumoniae in children," the researchers conclude.

They call for more research with high-quality prospective studies that address potential confounding, mixed infections, timing of intervention, and testing modalities.

Uncertainty, Both Ways

In an accompanying editorial, Andrew A. Colin, MD, from the Division of Pediatric Pulmonology and Department of Pediatrics at the Miller School of Medicine, University of Miami, Florida, and colleagues write that setting the parameters of such studies would be "a colossal undertaking indeed."

Children with M pneumoniae infections "mostly recover spontaneously, and it is difficult to assess how intervention and timing thereof within the course of the infection can be factored in when studying the results of therapies."

The editorialists conclude that the new study "further buttresses the uncertainty of the antibiotic treatment" of CA-LRTI secondary to M pneumonia but does not provide guidance for physicians in daily practice. "[B]y no means should it be construed as evidence against the use of macrolide (or other appropriate) antibiotics in bona fide [M pneumonia] cases."

The authors and editorialists have disclosed no relevant financial relationships.

Pediatrics. 2014;133:1081-1090, 1124-1125.

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