A Cochrane review [Abstract] 1 included 7 studies with a total of 1 912 children and 1 study with unknown number of children. Data interpretation was limited by the inability to extract data that specifically referred to children with M. pneumoniae. In most studies, clinical response did not differ between children randomised to a macrolide antibiotic and children randomised to a non-macrolide antibiotic. There was only one study of children randomised to any antibiotic versus placebo.In this study (of children with recurrent respiratory infections, whose acute lower respiratory tract infection (LRTI) was associated with Mycoplasma, Chlamydia or both by polymerase chain reaction, and/or paired sera) 100% of children treated with azithromycin had clinical resolution of their illness compared to 77% not treated with azithromycin at one month.
The review found insufficient evidence to draw any conclusions about the efficacy of antibiotics for LRTI secondary to M. pneumoniae in children (although one trial suggests macrolides may be efficacious in some children with LRTI secondary to Mycoplasma). The use of antibiotics has to be individualised and balanced with possible adverse events associated with antibiotic use.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), by inconsistency (heterogeneity in interventions and outcomes), and by imprecise results (lited study size for each comparison).
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