| Background:Mycoplasma pneumoniae is one of the the common pathogens in children and adults with community-acquired pneumonia (CAP), and Children (≥5years old) and young people are main risk group. Considering clinical need for economical and rapid diagnosis, the detection of Mycoplasma pneumoniae relies on serology tests. For a long time, researchers believe Mycoplasma pneumoniae infection is mild and self-limiting, but in recent years, with the development of detection technology, we found it not entirely true. Mycoplasma pneumoniae pneumonia is not only cause invasive infections, but also cause severe extrapulmonary disease, which is life-threatening, in some idiosyncratic and immune dysfunction crowd,. In the treatment of adults with Mycoplasma pneumoniae pneumonia, respiratory quinolones and macrolides is preferred. Howerver, azithromycin resistance phenomenon has been seen in a large number of studies. Choosing respiratory quinolones or macrolides relies on the effecacy, resistance and safety study.Objectives:To evaluate the efficacyn drug resistance and safety of levofloxacin in patients with Mycoplasma pneumoniae pneumonia in adults in comparison with therapy using azithromycin.Methords:To collect inpatient and outpatient clinical data of91cases between January1,2013and January1,2014in Shandong Provincial Hospital. The91patients were checked by Serologic tests (MP-IgM) in acute phase. Ninety one patients with MPP were randomly divided into three groups:azythromycin(32cases), azithromycin plus second-generation cephalosporins (cefotiam or cefuroxime)(25cases) and levofloxacin (34cases). Among them, azithromycin or azithromycin combined second-generation cephalosporins that were ineffective for five days would be instead of levofloxacin to continue the treatment.Results:There is no significant difference among the three groups of patients by age, sex, symptoms, signs and imaging (p>0.05).In91patients,78cases had a fever, accounting for85.71%.86patients had a cough, accounting for94.51%. Chest CT of77cases showed lesions blurred edges, low-density patchy infiltrates, accounting for84.62%. Chest auscultation and laboratory tests were not specific.5days after treatment,9cases of azithromycin and7cases of azithromycin plus second generation cephalosporin had had a fever and a cough without relief after5days treatment, which were instead of intravenous levofloxacin treatment. Levofloxacin group all were improved. Defervesce time, cough relief time and imaging lesions absorption time of Levofloxacin group is shoter than azithromycin group and azythromycin plus second-generation cephalosporin group. Levofloxacin group was statistically different from the other two group (p<0.05) s, and there was no significant difference between the azythromycin group and azythromycin plus second-generation cephalosporin group (p>0.05). After two weeks of clinical treatment, among azithromycin treatment group and combined treatment group,16cases had changed therapeutic regimen for levofloxacin treatment, in azithromycin group,6cases were cured,3cases treated markedly, in the combination therapy group,5patients were cured, two cases treated markedly. The treatment is effective. The azithromycin group remain23cases and the effective rate was86.96%, the total effective rate was62.50%The combined treatment group remain18casesand and the effective rate was88.89%, the total effective rate was64.00%. The levofloxacin group remain34cases, and the effective rate was91.18%. Excluding the group of the alternative levofloxacin cases, there was no significant difference in efficacy among the three groups (p>0.05). The total efficiency of levofloxacin group is higher than the azithromycin group and combined treatment group, and there is a significant difference among them(p<0.05). There is no significant difference between the total efficiency of the other two groups (p>0.05). After3weeks of treatment,16cases who had changed therapeutic regimen for levofloxacin treatment were treated effectivly. Excluding the group of the alternative levofloxacin cases, the effective rate of the three groups was100%. The total efficiency of azithromycin group was71.88%, and the total efficiency of the combined treatment group was72.00%. levofloxacin group and the other two groups were significantly different (p<0.05), the other two groups had no significant difference (p>0.05)Three groups had low incidence of adverse reactions, mainly gastrointestinal adverse reactions, the rates of side effects of the three groups was no significant difference(p>0.05).Conclusion:①Azythromycin-resistant MP exist in clinical treatment.②There is no therapeutic value difference between azithromycin combined Second-generation cephalosporin and azithromycin alone for treating mycoplasma pneumoniae pneumonia.③Efficacy of levofloxacin is higher than azithromycin.④Low incidence of adverse reactions in Levofloxacin and azithromycin, and there is no difference in safety between them.⑤In the clinical empiric treatment of adult MPP, respiratory quinolones such as levofloxacin is better.than azithromycin. |
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