Efficacy of early steroid use in Mycoplasma pneumoniae pneumonia

Hee Seong Kim; Myung Gon Song; Yong Wook Kim; Kyoung Sim Kim; Eun Young Kim; Young Kim; Hae In Jang; Hyung Min Cho

doi:10.4168/aard.2017.5.5.280

Journal List > Allergy Asthma Respir Dis > v.5(5) > 1059274

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Kim, Song, Kim, Kim, Kim, Kim, Jang, and Cho: Efficacy of early steroid use in Mycoplasma pneumoniae pneumonia

Original Article

Allergy Asthma Respir Dis 2017;5(5):280-286.

Published online: 5 September 2017

DOI: https://doi.org/10.4168/aard.2017.5.5.280

Efficacy of early steroid use in Mycoplasma pneumoniae pneumonia

Hee Seong Kim, Myung Gon Song, Yong Wook Kim, Kyoung Sim Kim, Eun Young Kim, Young Kim, Hae In Jang, Hyung Min Cho

Department of Pediatrics, Kwangju Christian Hospital, Gwangju, Korea

Correspondence to: Hyung Min Cho https://orcid.org/0000-0003-1263-5292 Department of Pediatrics, Kwangju Christian Hospital, 37 Yangnim-ro, Nam-gu, Gwangju 61661, Korea Tel: +82-62-650-5045, Fax: +82-62-650-5040, E-mail: drcho92@hanmail.net

Received 11 April 201721 July 2017 Accepted 24 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to evaluate whether or not the early use of steroid is useful for treating Mycoplasma pneumoniae pneumonia.

Methods

A prospective study was conducted on 85 patients with M. pneumoniae pneumonia admitted to Gwangju Christian Hospital between September 2015 and April 2016. A total of 85 patients were enrolled. Of these, 33 were treated with steroids (methylprednisolone 1 mg/kg/day), while 52 were not; both were treated with macrolides. The overall duration of fever was compared between the 2 groups and findings on chest radiographs were evaluated for their deterioration.

Results

The duration of fever after admission (1.36±0.92 days vs. 2.17±1.30 days, P =0.003) and the overall duration of fever (4.42±2.13 days vs. 6.07±2.59 days, P=0.003) were significantly lower in the steroid group. The duration of fever before admission was not different between the steroid and macrolide groups (3.06±1.74 days vs. 3.90±2.21 days, P=0.068). On chest radiographs taken 3 days later, 1 of 33 patients in the steroid group and 5 of 50 patients in the macrolide group worsened, although there was no statistically significant difference between the 2 groups (P=0.395). There was no significant difference in the duration of hospitalization between the 2 groups (6.72±1.54 days vs. 6.92±1.87 days, P=0.618).

Conclusion

Early administration of steroids on patients with M. pneumoniae pneumonia reduced the duration of fever, but there was no difference in duration of admission and x-ray deterioration.

Keywords: Mycoplasma pneumonia, Steroid, Macrolide

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Table 1.

Comparison of clinical and laboratory finding at admission between steroid treatment group and control group

Characteristic N	Not use of steroid (n=52)	Use of steroid (n=33)	P-value
Age (yr)	5.10±3.16	4.17±3.38	0.592
Sex			0.593
Male	16 (30.8)	12 (36.4)
Female	36 (69.2)	21 (63.6)
Type of pneumonia			0.373
Bronchopneumonia	28 (53.8)	21 (63.6)
Lobar pneumonia	24 (46.2)	12 (36.4)
No. of lobes in lobar pneumonia			0.473
1 Lobe	18/24 (75.0)	10/12 (83.3)
2 Lobes	5/24 (20.8)	2/12 (16.7)
≥3 Lobes	1/24 (4.2)	0/12 (0)
Laboratory finding
CRP (mg/dL)	2.24±2.40	2.34±2.76	0.858
LDH (U/L)	634.17±177.71	606.31±139.97	0.403
AST (U/L)	40.15±21.53	33.54±9.54	0.057
ALT (U/L)	19.92±18.15	21.54±25.67	0.753
Asthma	3 (0.06)	4 (0.12)	0.423
Atopic dermatitis	7 (0.13)	3 (0.09)	0.734

Values are presented as mean±standard deviation or number (%). CRP, C-reactive protein; LDH, lactate dehydrogenase; AST, aspartate aminotransfer-ase; ALT, alanine aminotransferase.

Table 2.

Comparison of clinical characteristics and changes of pneumonia findings between steroid treatment group and control group

Characteristic	Not use of steroid (n=52)	Use of steroid (n=33)	P-value
Fever duration
Fever duration after admission (day)	2.17±1.30	1.36±0.92	0.003
Fever duration total (day)	6.07±2.59	4.42±2.13	0.003
Fever duration before admission (day)	3.90±2.21	3.06±1.74	0.068
Fever duration of bronchopneumonia
Fever duration after admission (day)	2.10±1.34	1.33±0.79	0.023
Fever duration total (day)	5.96±2.80	3.95±1.74	0.006
Fever duration before admission (day)	3.85±2.23	2.61±1.24	0.027
Fever duration of lobar pneumonia
Fever duration after admission (day)	2.25±1.29	1.41±1.16	0.069
Fever duration total (day)	6.20±2.37	5.25±2.56	0.274
Fever duration before admission (day)	3.95±2.23	3.83±2.24	0.876
Hospitalization period (day)	6.92±1.87	6.72±1.54	0.618
Aggravation of pneumonia
Lobar pneumonia	3/24 (12.5)	0/12 (0)	0.536
Bronchopneumonia	2/26 (0.8)	1/21 (0.5)	1.000

Values are presented as mean±standard deviation or number (%).

Table 3.

Changes in laboratory findings on the first and fourth days of hospitalization

Characteristic	1st day of admission	4th day of admission	P-value∗
Not use of steroid
CRP (mg/dL)	2.68±2.70	1.09±0.32	0.002
LDH (U/L)	599.89±161.34	571.23±131.48	0.418
AST (U/L)	41.10±24.55	32.54±10.84	0.056
ALT (U/L)	20.95±20.36	21.92±21.23	0.841
Use of steroid
CRP (mg/dL)	2.82±3.05	0.61±0.90	0.002
LDH (U/L)	603.86±147.76	525.77±125.83	0.066
AST (U/L)	31.88±9.98	26.08±8.44	0.035
ALT (U/L)	22.79±30.02	18.08±5.51	0.454

Values are presented as mean±standard deviation.

CRP, C-reactive protein; LDH, Lactate dehydrogenase; AST, aspartate aminotransfer-ase; ALT, alanine aminotransferase.

^∗ Paired t-test

Table 4.

Baseline characteristics (n=85)

Characteristic	Value
Age (yr)	4.95±3.23
Sex
Male	28 (32.9)
Female	57 (67.1)
Use of steroid
Use	33 (38.8)
Not use	52 (61.1)
Previous history
Asthma	7 (8.2)
Atopic dermatitis	10 (11.7)
Type of pneumonia
Bronchopneumonia	49 (57.6)
Lobar pneumonia	36 (42.4)
No. of lobes in lobar pneumonia
1 Lobe	28/36 (77.8)
2 Lobes	7/36 (19.4)
≥3 Lobes	1/36 (2.8)

Values are presented as mean±standard deviation or number (%).

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