소아 Mycoplasma Pneumoniae 폐렴에서 스테로이드 치료가 질병 경과에 미치는 영향

Abstract

Background: Mycoplasma pneumoniae(M. pneumoniae) is a common etiology of community-acquired pneumonia in children occurring in an epidemic cycle of 3-4 years. Although M. pnuemoniaepneumonia(MPP)is usually treated effectively with macrolide antibiotics, it occasionally progresses to result in clinical and/or radiological deterioration. A prospective case control study performed in china showed that co-administration of steroid with macrolide in patients with MPP which was refractory to 7 or more days of macrolide therapy achieved defervescence and improvement in radiologic findings. This is a case control study performed domestically for the first time to evaluate the therapeutic effects of steroid when added to macrolide in the treatment of MPP in children. Methods: The study included children who were admitted to Hanyang University Seoul Hospital and Hanyang University Guri Hospital for the treatment of MPP from July 2010 to February 2011. The treatment group included 21 patients who were treated with steroid and macrolide antibiotics in Hanyang University Guri Hospital, and the control group included 21 patients who were treated only with macrolide antibiotics in Hanyang University Seoul Hospital and matched to the patients of the treatment group by age, sex, body temperature on admission and duration of fever before admission. Demographic, clinical, laboratory and radiological findings of the study patients were obtained from their medical records. The duration of fever, hospitalization and administration of macrolide antibiotics between the two groups were compared and analyzed. Results: The mean age of the patients was 6.3±3.7 years old, male to female ratio was 1.3:1, duration of fever before admission was 4.9±2.9 days, and mean of body temperature on admission was 39.1±0.8°C. No significant differences in demographic, clinical and laboratory findings were found between the two groups. The treatment group received intravenous methylprednisolone (2mg/kg/day, divided in two doses) for the mean duration of 4.9 days after 3.8 days of mean duration of macrolide antibiotics therapy. The treatment group had more proportion, although not statistically significant, of lobar pneumonia and pleural effusion and significantly more proportion of radiologic deterioration prior to the start of steroid therapy. The total mean duration of fever in all the study patients was 8.6±4.2 days and the mean duration of fever after macrolide therapy was 3.9±3.0 days with no statistical difference between the two groups. The fact, that the treatment group had similar physical findings but more severe radiologic presentation compared to the control group prior to the start of steroid therapy, may indicate that the treatment group would have suffered more clinically as well as radiologically without steroid administration. Conclusion: This study indicates that therapeutic effects of steroid use within 7days after macrolide antibiotics treatment in patients with MPP were similar to the results reported in previous studies in that steroid started after 7 or more days of macrolide antibiotics treatment. These results suggest the need for a prospective investigation to illustrate the effect of steroid in the clinical courses of MPP in order to present the proper time for the use of steroid in the treatment of MPP.