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Low-dose versus high-dose methylprednisolone for children with severe Mycoplasma pneumoniae pneumonia (MCMP): A

Baoping Xu1, Ling Cao2, Yunxiao Shang3

  • 1Department of Respiratory Disease Beijing Children's Hospital, Capital Medical University China National Clinical Research Center of Respiratory Diseases National Center for Children's Health Beijing China.

Pediatric Investigation
|September 19, 2025
PubMed
Abstract

Insights

Low-dose methylprednisolone with azithromycin is as effective as high-dose for preventing long-term pulmonary lesions in severe Mycoplasma pneumoniae pneumonia (MPP). The low-dose regimen offers a better safety profile, reducing risks like hypertension.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Pulmonology

Background:

  • Severe Mycoplasma pneumoniae pneumonia (MPP) can lead to long-term pulmonary complications.
  • Macrolide and glucocorticoid therapy is effective in preventing these lesions, but optimal glucocorticoid dosage remains unclear.

Purpose of the Study:

  • To compare the efficacy and safety of low-dose versus high-dose methylprednisolone combined with azithromycin in treating severe pediatric MPP.
  • To assess the impact of different methylprednisolone doses on the risk of long-term pulmonary lesions.

Main Methods:

  • A randomized, parallel-controlled, multicenter clinical trial involving 424 pediatric patients with severe MPP.
  • Patients received azithromycin plus either low-dose (2 mg/kg/d) or high-dose (10 mg/kg/d) methylprednisolone for 3 days, followed by a 12-day taper.
  • The primary outcome was the incidence of composite adverse pulmonary outcomes (atelectasis, bronchiectasis, bronchiolitis obliterans) at 6 months.

Main Results:

  • The incidence of long-term pulmonary lesions was 24.4% in the low-dose group and 31.3% in the high-dose group (Risk Ratio: 1.28, 95% CI: 0.94-1.75).
  • Hypertension occurred in 1.4% of the low-dose group versus 8.1% in the high-dose group (Risk Ratio: 5.72, 95% CI: 1.70-19.23).

Conclusions:

  • Low-dose methylprednisolone combined with azithromycin is non-inferior to high-dose therapy for preventing pulmonary lesions in severe pediatric MPP.
  • The low-dose regimen offers a superior safety profile, with significantly lower rates of hypertension.
Keywords:
ChildrenGlucocorticoidsLong‐term pulmonary lesionsMycoplasma pneumoniaePneumonia

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