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Yoo, Choi, Chun, Ahn, Cho, Lee, Sung, and Lee: Current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital
Original Article

Allergy Asthma Respir Dis 2018;6(2):122-127.

Published online: 5 March 2018

DOI: https://doi.org/10.4168/aard.2018.6.2.122

Current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital

Susie Yoo, Seong Eun Choi, Jiyoung Chun, Yo Han Ahn, Ky Young Cho, Yong Ju Lee, Tae Jung Sung, Kon Hee Lee

Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea

Correspondence to: Yong Ju Lee https://orcid.org/0000-0002-0796-2558 Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-829-5142, Fax: +82-2-845-4469, E-mail: pedalllee@gmail.com

Received 27 July 201716 September 2017       Accepted 16 September 2017

Copyright © 2018 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma

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

Steroids can be used as an adjuvant therapy in the management of mycoplasma pneumonia, but no definite guidelines for the use of steroids have been established. The purpose of this study was to analyze the current usage and effects of steroids in the management of childhood mycoplasma pneumonia in a secondary hospital in Korea.

Methods

We retrospectively reviewed the medical records of 152 patients who were admitted due to mycoplasma pneumonia. The patients were divided into 3 groups as follows: those who did not use steroids (81 patients, 53%), those who used steroids after their fever subsided (42 patients, 28%) and those who used steroids during fever (29 patients, 19%).

Results

In decreasing order of values, the duration of fever during hospitalization (60.0±40.2 hours vs. 37.3±28.5 hours vs. 29.7±29.5 hours, P=0.006) and duration of hospitalization (5.9±1.7 days vs. 5.0±1.4 days vs. 4.0±1.5 days, P<0.001) were reported in the group which received steroids during fever, the group which received steroids after the fever subsided and the group which did not receive steroids. In the group which received steroids during fever, patients with early steroid use (within 24 hours) had a shorter fever duration in the hospital (12.0 hours vs. 73.5 hours, P <0.001) and a hospitalization duration (5.0 days vs. 6.5 days, P=0.007) than those with late steroid use (after 24 hours).

Conclusion

Steroids were used in 47% of patients with mycoplasma pneumonia. The patients who received early steroids had a shorter fever duration and a shorter hospital stay than those who received late steroids.

Keywords: Mycoplasma pneumonia, Steroids, Child

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Fig. 1.
Comparison of fever duration (hr) after admission in 2 groups according to steroid start time (within 24 hours vs. after 24 hours).
aard-6-122f1.tif
Fig. 2.
Comparison of duration of hospitalization (day) in 2 groups according to steroid start time (within 24 hours vs. after 24 hours).
aard-6-122f2.tif
Table 1.
Comparison of demographic data, duration of fever and hospitalization in each group of subjects
Variable Group I Group II Group III P-value
No. of patients 81 (53) 42 (28) 29 (19)  
Age (yr) 4.7±3.0 4.5±2.5 4.3±2.8 0.804
Sex, male:female 33:48 23:19 16:13 0.217
Fever duration (day)        
 Before admission 4.1±2.3 4.3±1.9 3.8±2.0 0.638
 After admission 29.7±29.5 37.3±28.5 60.0±40.2 0.006∗
Duration of hospitalization (day) 4.0±1.5 5.0±1.4 5.9±1.7 <0.001∗
Rash 2 (1.2) 0 (0) 1 (3.4) 0.529
Vomiting 10 (12.3) 6 (14.3) 7 (24.1) 0.310
Diarrhea 8 (9.9) 7 (16.7) 5 (17.2) 0.441

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

Group I, treatment without steroids; group II, steroid use after fever subside; group III, steroid use with fever.

Scale variables were analyzed using analysis of variance, nominal variables were analyzed chi-square test.

∗ P<0.05, statistically significant differences.

Table 2.
Comparison of type of pneumonia and treatment in each group of subjects
Variable Group I Group II Group III P-value
Type       0.004∗
 Bronchopneumonia 77 (95.0) 36 (85.7) 21 (72.4)  
 Lobar pneumonia 4 (4.9) 6 (14.2) 8 (27.5)  
Macrolide       0.083
 Azithromycin 31 (40.7) 23 (57.5) 18 (72.0)  
 Roxithromycin 38 (50.0) 13 (32.5) 4 (16)  
 Clarithromycin 7 (9.2) 3 (7.5) 3 (12)  
 Levofloxacin - 1 (2.5) -  
Steroid dose (mg/kg) - 1.2±0.2 1.2±0.2 0.930
Steroid duration (day) - 3.5±1.0 4.8±1.1 <0.001∗

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

Group I, treatment without steroids; group II, steroid use after fever subside; group III, steroid use with fever.

Type of pneumonia and macrolide use were analyzed using chi-square test.

Steroid dose and duration were analyzed using t-test.

∗ P<0.05, statistically significant differences.

Table 3.
Comparison of blood test results in each group of subjects
Variable Group I Group II Group III P-value
WBC (×103/μL) 9.63±4.52 7.99±2.61 8.45±3.45 0.066
Hb (g/dL) 12.3±0.8 12.1±1.0 11.9±0.8 0.130
Neutrophil counts (×103/μL) 5.94±3.57 4.65±1.52 4.33±1.74 0.009∗
Neutrophils (%) 59.8±13.8 57.8±14.3 52.5±12.4 0.050
ESR (mm/hr) 28.7±17.0 28.2±12.8 22.7±12.3 0.174
CRP (mg/L) 24.1±26.1 22.9±17.5 20.4±18.3 0.757
LDH (IU/L) 306.0±64.0 343.0±56.0 363.0±92.0 0.001∗
AST (IU/L) 32.4±8.7 39.9±17.8 39.1±9.9 0.002∗
ALT (IU/L) 14.2±5.0 21.8±30.4 15.6±4.9 0.051

Values are presented as mean±standard deviation.

Group I, treatment without steroids; group II, steroid use after fever subside; group III, steroid use with fever; WBC, white blood cells; Hb, hemoglobin; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; LDH, lactate dehydrogenase; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

Values were analyzed using analysis of variance.

∗ P<0.05, statistically significant differences.

Table 4.
Comparison of demographic data in 2 groups according to steroid start time
Variable Steroid use P-value
Within 24 hr (n=13) After 24 hr (n=16)
Age (yr) 2.9 (1.7–5.7) 5.2 (2.3–5.8) 0.503
Sex, male:female 7:6 9:7  
Fever duration before admission (day) 3.0 (1.0, 4.0) 5.0 (3.3, 5.8) 0.015∗
Type     0.031∗
Bronchopneumonia 12 (92.3) 9 (56.3)  
Lobar pneumonia 1 (7.7) 7 (43.7)  

Values are presented as median (interquartile range) or number (%).

Values were analyzed using Mann-Whitney U-test.

∗ P<0.05, statistically significant differences.

Table 5.
Comparison of blood test results in two groups according to steroid start time
Variable Steroid use P-value
Within 24 hr After 24 hr
WBC (×103/μL) 8.53 (6.48–12.41) 7.23 (5.51–10.22) 0.374
Hb (g/dL) 12.0 (11.5–12.9) 11.8 (11.4–12.4) 0.545
Neutrophil counts (×103/μL) 4.22 (2.93–5.84) 4.85 (2.57–5.32) 0.880
Neutrophils (%) 48.3 (41.5–56.5) 58.3 (45.9–63.7) 0.199
ESR (mm/hr) 21 (15–31) 23 (11.5–29.8) 0.846
CRP (mg/L) 9.4 (5.8–18.0) 19.0 (9.8–46.4) 0.068
LDH (IU/L) 317 (269–348) 372 (314–476) 0.077
AST (IU/L) 34 (29–43) 41 (37–43) 0.156
ALT (IU/L) 15 (13–20) 14 (12–16) 0.156

Values are presented as median (interquartile range).

WBC, white blood cell; Hb, hemoglobin; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; LDH, lactate dehydrogenase; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

Values were analyzed using Mann-Whitney U-test.

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