Clinical Question

In children with confirmed mycoplasma pneumonia, is treatment effective in decreasing the duration of symptoms?

Bottom Line

After all these years of knowing about Mycoplasma pneumoniae as a cause of lower respiratory tract infections and the effectiveness of various antibiotics against it in a Petri dish, we still do not know whether treating mycoplasma pneumonia in children is effective. This study does not tell us to stop testing and treating, but it does not tell us to start, either. (Level of Evidence = 1a–)

Synopsis

The authors of this meta-analysis searched PubMed for observational and randomized trials evaluating antibiotic treatment of confirmed lower respiratory tract infections caused by M. pneumoniae in children. They searched bibliographies of identified studies, but did not search other databases and thus may have missed applicable articles. They did not include unpublished studies, but included studies published in any language. Because most of the studies enrolled children with pneumonia due to any cause who were given antibiotics effective against several organisms, the authors had to do a bit of statistical jujutsu to produce relevant results for just the children with mycoplasma. Study quality was reviewed, but the assessment focused on various selection and reporting biases rather than on indicators of study conduct as is typically done in meta-analysis. In their analysis of the five randomized controlled studies (N = 2,233), the authors found no evidence to support or refute treatment. Individually, four of the five studies found no benefit, although there was heterogeneity among the studies and also a risk of publication bias.

Study design: Meta-analysis (other)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: BiondiEMcCullohRAlversonBKleinADixonATreatment of mycoplasma pneumonia: a systematic review. Pediatrics2014; 133( 6): 1081– 1090.