Clinical efficacy of levofloxacin versus minocycline in the treatment of children with macrolide-resistant Mycoplasma pneumoniae pneumonia

doi:10.3969/j.issn.1004-583X.2025.09.008

Abstract

Abstract:

Objective To compare the clinical efficacy and safety of levofloxacin versus minocycline in treating children with macrolide-resistant $M y c o p l a s m a p n e u m o n i a e$ pneumonia (MRMP), and to analyze the therapeutic differences between the two drugs in mild, moderate, and critical subgroups, thus providing a basis for the drug use in MRMP. Methods A total of 204 children with MRMP admitted to the Eighth Medical Center of the PLA General Hospital and the First Affiliated Hospital of Xinxiang Medical University from May 2023 to October 2024 were included. They were divided into the levofloxacin group ( $n$ =65) and the minocycline group ( $n$ =139) based on the treatment drug. Outcomes included rehabilitation indicators (e.g., temperature recovery, cough relief, disappearance of rales), inflammatory indicators, overall effectiveness, and short-term and long-term adverse reactions. Results There was no significant difference in the overall effectiveness rate between the levofloxacin group and the minocycline group ( $P$ >0.05). Body temperature recovery time, cough relief time, wheezing relief time, blister sound disappearance time and imaging improvement time were comparable between the two groups ( $P$ >0.05). Differences in the white blood cell count, C-reactive protein, procalcitonin, erythrocyte sedimentation rate, interleukin-6, lactate dehydrogenase and other inflammatory indicators before and after treatment were comparable between the two groups ( $P$ >0.05). However, in the critical subgroup, the time for rales to disappear in the minocycline group was significantly shorter than that in the levofloxacin group ( $P$ <0.05). In terms of safety, short-term adverse reactions were mainly mild gastrointestinal reactions, without abnormalities in liver and kidney functions and long-term adverse reactions. Conclusion The overall efficacy and safety of levofloxacin and minocycline in treating children with MRMP are comparable. Minocycline, due to its high lipid solubility and strong lung tissue penetration, can relieve pulmonary signs faster in critically ill children. Clinicians should develop individualized treatment plans based on the age of children and the severity of the disease.

Key words: children, macrolide-resistant $Mycoplasma\mathrm{ }pneumoniae$ $M y c o p l a s m a p n e u m o n i a e$ pneumonia, levofloxacin, minocycline

CLC Number:

R725.6

Liu Jiao, Shang Yun, Cui Qingyang, Zhang He, Qiu Meng. Clinical efficacy of levofloxacin versus minocycline in the treatment of children with macrolide-resistant Mycoplasma pneumoniae pneumonia[J]. Clinical Focus, 2025, 40(9): 821-827.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.09.008

https://www.lchc.cn/EN/Y2025/V40/I9/821

Figures/Tables 12

Tab.1 Comparison of general data between the two groups

组别	例数	性别[例(%)]		年龄 (岁)	病情严重程度[例(%)]			住院时间 (d)	支原体耐药阳性[例(%)]
组别	例数	男	女	年龄 (岁)	轻症	中症	重症	住院时间 (d)	支原体耐药阳性[例(%)]
左氧氟沙星组	65	36(55.4)	29(44.6)	7.28±3.17	5(7.7)	52(80.0)	8(12.3)	9.05±2.77	57(87.7)
米诺环素组	139	74(53.2)	65(46.8)	8.76±2.64	15(10.8)	108(77.7)	16(11.5)	7.56±2.14	117(84.2)
统计值		χ²=0.642		$t$ =0.613	χ²=2.781			$t$ =1.204	χ²=0.593
$P$ 值		0.422		0.541	0.257			0.229	0.443

Tab.1 Comparison of general data between the two groups

组别	例数	性别[例(%)]		年龄 (岁)	病情严重程度[例(%)]			住院时间 (d)	支原体耐药阳性[例(%)]
组别	例数	男	女	年龄 (岁)	轻症	中症	重症	住院时间 (d)	支原体耐药阳性[例(%)]
左氧氟沙星组	65	36(55.4)	29(44.6)	7.28±3.17	5(7.7)	52(80.0)	8(12.3)	9.05±2.77	57(87.7)
米诺环素组	139	74(53.2)	65(46.8)	8.76±2.64	15(10.8)	108(77.7)	16(11.5)	7.56±2.14	117(84.2)
统计值		χ²=0.642		$t$ =0.613	χ²=2.781			$t$ =1.204	χ²=0.593
$P$ 值		0.422		0.541	0.257			0.229	0.443

Tab.2 Comparison of clinical efficacy between the two groups (n, %)

组别	例数	显效	有效	无效	总有效
左氧氟沙星组	65	20(30.8)	25(38.4)	20(30.8)	45(69.2)
米诺环素组	139	40(28.8)	58(41.7)	41(29.5)	98(70.5)
χ²值					1.740
$P$ 值					0.418

Tab.2 Comparison of clinical efficacy between the two groups (n, %)

组别	例数	显效	有效	无效	总有效
左氧氟沙星组	65	20(30.8)	25(38.4)	20(30.8)	45(69.2)
米诺环素组	139	40(28.8)	58(41.7)	41(29.5)	98(70.5)
χ²值					1.740
$P$ 值					0.418

Tab.3 Comparison of rehabilitation indicators between the two groups

指标	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	影像学改善(d)
左氧氟沙星组	65	1.46±0.76	2.22±1.05	3.00±1.12	4.43±2.04	9.27±2.76
米诺环素组	139	1.32±0.71	2.04±0.87	2.81±1.08	4.10±2.03	8.89±2.58
$t$ 值		1.122	1.117	0.994	0.962	1.007
$P$ 值		0.263	0.265	0.322	0.337	0.315

Tab.3 Comparison of rehabilitation indicators between the two groups

指标	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	影像学改善(d)
左氧氟沙星组	65	1.46±0.76	2.22±1.05	3.00±1.12	4.43±2.04	9.27±2.76
米诺环素组	139	1.32±0.71	2.04±0.87	2.81±1.08	4.10±2.03	8.89±2.58
$t$ 值		1.122	1.117	0.994	0.962	1.007
$P$ 值		0.263	0.265	0.322	0.337	0.315

Tab.4 Comparison of inflammatory indicators between the two groups

组别	例数		WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	65		7.68±2.87		6.12±2.35		13.52±10.84		1.28±0.96		0.25±0.18		0.10±0.06
米诺环素组	139		7.24±2.76		5.98±2.28		14.77±12.36		1.45±1.12		0.23±0.16		0.09±0.05
$t$ 值			1.014		0.373		-0.624		-0.918		0.684		1.017
$P$ 值			0.312		0.710		0.533		0.360		0.495		0.310
组别		ESR(mm/h)				IL-6(ng/L)				LDH(U/L)
组别		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组		14.67±9.25		12.56±7.43		10.54±8.62		2.15±1.43		247.54±68.73		206.38±54.62
米诺环素组		13.88±8.76		11.94±7.02		11.23±9.15		2.08±1.36		238.67±63.45		201.47±51.34
$t$ 值		0.518		0.517		-0.449		0.292		0.829		0.543
$P$ 值		0.605		0.606		0.654		0.771		0.408		0.588

Tab.4 Comparison of inflammatory indicators between the two groups

组别	例数		WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	65		7.68±2.87		6.12±2.35		13.52±10.84		1.28±0.96		0.25±0.18		0.10±0.06
米诺环素组	139		7.24±2.76		5.98±2.28		14.77±12.36		1.45±1.12		0.23±0.16		0.09±0.05
$t$ 值			1.014		0.373		-0.624		-0.918		0.684		1.017
$P$ 值			0.312		0.710		0.533		0.360		0.495		0.310
组别		ESR(mm/h)				IL-6(ng/L)				LDH(U/L)
组别		治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组		14.67±9.25		12.56±7.43		10.54±8.62		2.15±1.43		247.54±68.73		206.38±54.62
米诺环素组		13.88±8.76		11.94±7.02		11.23±9.15		2.08±1.36		238.67±63.45		201.47±51.34
$t$ 值		0.518		0.517		-0.449		0.292		0.829		0.543
$P$ 值		0.605		0.606		0.654		0.771		0.408		0.588

Tab.5 Comparison of short-term adverse reactions between the two groups (n, %)

组别	例数	胃肠反应	肝功能异常	肾功能异常	皮疹	心脏副作用
左氧氟沙星组	65	7(10.8)	0	0	3(4.6)	0
米诺环素组	139	12(8.6)	0	0	6(4.3)	0
χ²值		0.334	-	-	0.015	-
$P$ 值		0.563	-	-	0.903	-

Tab.5 Comparison of short-term adverse reactions between the two groups (n, %)

组别	例数	胃肠反应	肝功能异常	肾功能异常	皮疹	心脏副作用
左氧氟沙星组	65	7(10.8)	0	0	3(4.6)	0
米诺环素组	139	12(8.6)	0	0	6(4.3)	0
χ²值		0.334	-	-	0.015	-
$P$ 值		0.563	-	-	0.903	-

Tab.6 Comparison of long-term adverse reactions between the two groups (n, %)

组别	例数	肌腱炎、跟腱断裂	关节痛	软骨发育不良	四环素牙
左氧氟沙星组	65	0	0	0	0
米诺环素组	139	0	0	0	0
χ²值		-	-	-	-
$P$ 值		-	-	-	-

Tab.6 Comparison of long-term adverse reactions between the two groups (n, %)

组别	例数	肌腱炎、跟腱断裂	关节痛	软骨发育不良	四环素牙
左氧氟沙星组	65	0	0	0	0
米诺环素组	139	0	0	0	0
χ²值		-	-	-	-
$P$ 值		-	-	-	-

Tab.7 Comparison of inflammatory indicators in the mild group

组别	例数	WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	5	8.53±2.05		7.04±1.53		10.08±5.06		2.03±1.08		0.23±0.12		0.12±0.06
米诺环素组	15	7.08±1.85		6.04±1.58		9.06±4.58		2.53±1.27		0.19±0.09		0.09±0.05
$t$ 值		1.400		1.260		0.400		-0.860		0.680		1.010
$P$ 值		0.176		0.221		0.693		0.400		0.504		0.324
组别	LDH(U/L)				ESR(mm/h)				IL-6(ng/L)
组别	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	220.35±50.47		200.28±40.56		12.34±6.08		10.45±5.09		10.45±5.08		3.06±1.57
米诺环素组	210.46±45.58		190.37±35.67		11.45±5.56		9.45±4.58		9.45±4.59		3.58±1.87
$t$ 值	0.390		0.490		0.290		0.390		0.390		-0.610
$P$ 值	0.701		0.629		0.775		0.699		0.701		0.548

Tab.7 Comparison of inflammatory indicators in the mild group

组别	例数	WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	5	8.53±2.05		7.04±1.53		10.08±5.06		2.03±1.08		0.23±0.12		0.12±0.06
米诺环素组	15	7.08±1.85		6.04±1.58		9.06±4.58		2.53±1.27		0.19±0.09		0.09±0.05
$t$ 值		1.400		1.260		0.400		-0.860		0.680		1.010
$P$ 值		0.176		0.221		0.693		0.400		0.504		0.324
组别	LDH(U/L)				ESR(mm/h)				IL-6(ng/L)
组别	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	220.35±50.47		200.28±40.56		12.34±6.08		10.45±5.09		10.45±5.08		3.06±1.57
米诺环素组	210.46±45.58		190.37±35.67		11.45±5.56		9.45±4.58		9.45±4.59		3.58±1.87
$t$ 值	0.390		0.490		0.290		0.390		0.390		-0.610
$P$ 值	0.701		0.629		0.775		0.699		0.701		0.548

Tab.8 Comparison of inflammatory indicators in the moderate group

组别	例数	WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	52	7.56±2.58		6.55±2.06		15.07±8.09		3.04±1.56		0.27±0.16		0.13±0.07
米诺环素组	108	7.86±2.87		6.85±2.28		14.09±7.56		3.58±1.86		0.24±0.13		0.12±0.06
$t$ 值		-0.660		-0.830		0.730		-1.920		1.180		0.880
$P$ 值		0.510		0.408		0.466		0.056		0.240		0.380
组别	LDH(U/L)				ESR(mm/h)				IL-6(ng/L)
组别	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	240.56±60.78		210.45±50.67		15.56±8.07		12.45±6.06		12.56±6.09		4.08±2.07
米诺环素组	230.67±55.78		205.56±45.89		14.56±7.59		11.56±5.58		11.56±5.58		4.59±2.29
$t$ 值	0.990		0.590		0.750		0.890		1.000		-1.410
$P$ 值	0.324		0.556		0.454		0.374		0.319		0.160

Tab.8 Comparison of inflammatory indicators in the moderate group

组别	例数	WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	52	7.56±2.58		6.55±2.06		15.07±8.09		3.04±1.56		0.27±0.16		0.13±0.07
米诺环素组	108	7.86±2.87		6.85±2.28		14.09±7.56		3.58±1.86		0.24±0.13		0.12±0.06
$t$ 值		-0.660		-0.830		0.730		-1.920		1.180		0.880
$P$ 值		0.510		0.408		0.466		0.056		0.240		0.380
组别	LDH(U/L)				ESR(mm/h)				IL-6(ng/L)
组别	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	240.56±60.78		210.45±50.67		15.56±8.07		12.45±6.06		12.56±6.09		4.08±2.07
米诺环素组	230.67±55.78		205.56±45.89		14.56±7.59		11.56±5.58		11.56±5.58		4.59±2.29
$t$ 值	0.990		0.590		0.750		0.890		1.000		-1.410
$P$ 值	0.324		0.556		0.454		0.374		0.319		0.160

Tab.9 Comparison of inflammatory indicators in the critical group

组别	例数	WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	8	9.08±3.09		7.59±2.57		20.05±10.07		4.03±2.08		0.32±0.21		0.16±0.09
米诺环素组	16	8.59±3.26		7.28±2.89		18.07±9.08		4.56±2.27		0.29±0.19		0.15±0.08
$t$ 值		0.360		0.270		0.470		-0.570		0.340		0.270
$P$ 值		0.723		0.790		0.644		0.573		0.737		0.790
组别	LDH(U/L)				ESR(mm/h)				IL-6(ng/L)
组别	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	260.89±70.91		230.78±60.82		18.78±10.09		14.56±7.08		15.67±8.09		5.01±2.58
米诺环素组	250.89±65.91		220.78±55.82		13.67±6.59		17.67±9.08		14.67±7.09		6.38±2.89
$t$ 值	0.330		0.390		1.300		-0.920		0.300		-0.420
$P$ 值	0.743		0.701		0.206		0.367		0.767		0.073

Tab.9 Comparison of inflammatory indicators in the critical group

组别	例数	WBC计数(×10⁹/L)				CRP(mg/L)				PCT(μg/L)
组别	例数	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	8	9.08±3.09		7.59±2.57		20.05±10.07		4.03±2.08		0.32±0.21		0.16±0.09
米诺环素组	16	8.59±3.26		7.28±2.89		18.07±9.08		4.56±2.27		0.29±0.19		0.15±0.08
$t$ 值		0.360		0.270		0.470		-0.570		0.340		0.270
$P$ 值		0.723		0.790		0.644		0.573		0.737		0.790
组别	LDH(U/L)				ESR(mm/h)				IL-6(ng/L)
组别	治疗前		治疗后		治疗前		治疗后		治疗前		治疗后
左氧氟沙星组	260.89±70.91		230.78±60.82		18.78±10.09		14.56±7.08		15.67±8.09		5.01±2.58
米诺环素组	250.89±65.91		220.78±55.82		13.67±6.59		17.67±9.08		14.67±7.09		6.38±2.89
$t$ 值	0.330		0.390		1.300		-0.920		0.300		-0.420
$P$ 值	0.743		0.701		0.206		0.367		0.767		0.073

Tab.10 Comparison of rehabilitation indicators in the mild group

组别	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	住院天数(d)	影像学改善(d)
左氧氟沙星组	5	1.23±0.35	1.14±0.46	2.45±0.58	3.56±1.67	6.78±0.89	7.56±1.34
米诺环素组	15	1.18±0.42	1.27±0.53	2.23±0.67	3.24±1.45	5.67±0.92	7.89±1.56
$t$ 值		0.280	-0.620	0.890	0.540	1.230	-0.480
$P$ 值		0.781	0.542	0.385	0.595	0.228	0.636

Tab.10 Comparison of rehabilitation indicators in the mild group

组别	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	住院天数(d)	影像学改善(d)
左氧氟沙星组	5	1.23±0.35	1.14±0.46	2.45±0.58	3.56±1.67	6.78±0.89	7.56±1.34
米诺环素组	15	1.18±0.42	1.27±0.53	2.23±0.67	3.24±1.45	5.67±0.92	7.89±1.56
$t$ 值		0.280	-0.620	0.890	0.540	1.230	-0.480
$P$ 值		0.781	0.542	0.385	0.595	0.228	0.636

Tab.11 Comparison of rehabilitation indicators in the moderate group

组别	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	住院天数(d)	影像学改善(d)
左氧氟沙星组	52	1.56±0.67	2.15±0.89	3.23±1.28	4.78±2.56	9.34±2.15	9.23±2.11
米诺环素组	108	1.35±0.73	1.89±0.84	2.95±1.34	3.89±2.23	7.56±1.78	9.08±2.05
$t$ 值		1.470	1.730	1.120	1.890	1.980	0.380
$P$ 值		0.144	0.086	0.265	0.062	0.051	0.705

Tab.11 Comparison of rehabilitation indicators in the moderate group

组别	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	住院天数(d)	影像学改善(d)
左氧氟沙星组	52	1.56±0.67	2.15±0.89	3.23±1.28	4.78±2.56	9.34±2.15	9.23±2.11
米诺环素组	108	1.35±0.73	1.89±0.84	2.95±1.34	3.89±2.23	7.56±1.78	9.08±2.05
$t$ 值		1.470	1.730	1.120	1.890	1.980	0.380
$P$ 值		0.144	0.086	0.265	0.062	0.051	0.705

Tab.12 Comparison of rehabilitation indicators in the critical group

组别	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	住院天数(d)	影像学改善(d)
左氧氟沙星组	8	1.38±0.49	2.36±0.68	3.45±1.34	5.89±1.87	10.56±2.58	10.45±2.56
米诺环素组	16	1.26±0.51	2.12±0.93	2.68±1.12	4.25±1.78	6.89±1.45	10.12±2.34
$t$ 值		-0.650	0.710	1.580	2.320	2.010	0.360
$P$ 值		0.521	0.485	0.128	0.029	0.056	0.722

Tab.12 Comparison of rehabilitation indicators in the critical group

组别	例数	体温恢复(d)	咳嗽缓解(d)	喘息缓解(d)	水泡音消失(d)	住院天数(d)	影像学改善(d)
左氧氟沙星组	8	1.38±0.49	2.36±0.68	3.45±1.34	5.89±1.87	10.56±2.58	10.45±2.56
米诺环素组	16	1.26±0.51	2.12±0.93	2.68±1.12	4.25±1.78	6.89±1.45	10.12±2.34
$t$ 值		-0.650	0.710	1.580	2.320	2.010	0.360
$P$ 值		0.521	0.485	0.128	0.029	0.056	0.722

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