Classification of Mycoplasma pneumoniae infection is more effective

General treatment of Mycoplasma pneumoniae infection:

(1) Respiratory isolation: because mycoplasma infection can cause a small epidemic, and the time of excreting mycoplasma after the disease of the child is long, up to 1~2 months, the infant period only shows symptoms of upper respiratory tract infection.Pneumonia occurs only after superinfection. At the same time, it is easy to be reinfected with other viruses during MP infection, resulting in aggravation and prolongation of the disease, so respiratory isolation should be done as much as possible for children or children with a history of close contact to prevent reinfection and cross-infection.

(2) Nursing: Attention should be paid to rest, nursing and diet. If necessary, a small amount of antipyretic drugs can be taken, and Chinese medicine can be taken Keep the indoor air fresh, keep the room temperature at 18~20 °C, the relative humidity at 60% is appropriate, and provide easy to digest, nutritious food and enough liquids. Maintain oral hygiene and airway patency, frequently turn over the child, pat the back, change the position, promote the discharge of secretions, and if necessary, appropriately suction sputum to eliminate viscous secretions.

(3) Oxygen therapy: Oxygen should be given in time for those with severe hypoxia or severe airway obstruction. The method is the same as for general pneumonia.

Symptomatic management:

(1) expectorant: the purpose is to make the sputum thinner, easy to discharge, otherwise it is easy to increase the chance of bacterial infection, but there are few effective expectorants, in addition to strengthening the turnover, patting the back, atomization, sputum suction, can choose to use bromhexine (biyuping), acetylcysteine (phlegm is easy to clean) and other expectorants. Because cough is the most prominent clinical manifestation of mycoplasma pneumonia, frequent and severe cough will interfere with the child's sleep and rest, and sedatives chloral hydrate or phenobarbital can be appropriately given.Low-dose codeine is given as appropriate, but not too often.

(2) Antiasma: For patients with severe asthma, bronchodilators, such as aminophylline, can be taken orally for 4~6mg/(kgd) for 6 hours; It can also be inhaled with albuterol (salbutamol).

Antipathogenic therapy for Mycoplasma pneumoniae infection:

Route and duration of administration:

For mild Mycoplasma pneumoniae infection, drugs can be taken by mouth, including erythromycin and newer macrolides such as azithromycin, clarithromycin, and roxithromycin.

The 2005 edition of the Pharmacopoeia of the People's Republic of China clearly states that the clinical medication instructions for pediatric use in China are too many choices for intravenous administration, and the 2005 edition of the Pharmacopoeia of the People's Republic of China clearly states:

The duration of mycoplasma infection varies depending on the site of the lesion, and mild upper respiratory tract infections usually range from L0 to 14 days. It should be noted that some children may continue to present mycoplasma in respiratory secretions for several months after treatment, resulting in recurrence and dissemination. The recommended course of treatment for mycoplasma pneumonia is 2-3WK for mild cases, 4WK for severe cases, and it will be longer for some cases, depending on the specific condition.

Optional drugs and their dosages:

The minimum inhibitory mass concentration of erythromycin:mycoplasma was 0.0156 tzg/mL, and the ratio of intracellular to extracellular levels was 6.6:1.30-50mg/(kgd) for children, divided into 3~4 oral doses. Intravenous infusion can also be used, and patients with MP is the strongest indication for intravenous erythromycin.

Roxithromycin: 5~10mg/(kgd) for children, divided into 2 oral doses.

Azithromycin: 10mg/(kgd) for children, once orally, the effective tissue level can be maintained for 7 days after oral administration for 3 days, so it is discontinued for 4 days as a course of treatment. The usual regimen used abroad is: 10mg/kg on the first day, 5mg/kg on the 2nd ~ 5th day, and the total dose is still 30mg/kg. Clinical overuse of intravenous azithromycin should be corrected. Patients with severe MP pneumonia and pleurisy can be treated intravenously in the acute phase of the disease, but sequential therapy should also be used, and the drug should be changed to VI administration in a timely manner.

Clarithromycin: the dosage is l0~15mg/(kgd), divided into 2 oral doses. Spiramycin, crosssamycin, etc., have been less commonly used in pediatrics.

Anti-inflammatory therapy for Mycoplasma pneumoniae infection:

1. Glucocorticoids

The pathological changes caused by mycoplasma infection are caused by the pathogen itself and the immune response it provokes, so mycoplasma infection is also an autoimmune disease. Glucocorticoids can be used in combination with antibiotics for the rapid development of acute disease and severe mycoplasma infection or pulmonary disease that prolongs bronchiolitis obliterans, atelectasis, pulmonary fibrosis, bronchiectasis, or extrapulmonary complications due to the rapid development of acute disease and severe mycoplasma infection or pulmonary disease changes.A murine MP pneumonia model was used to observe whether glucocorticoids could inhibit the MP-induced immune response, and were divided into three groups: minomycin group, minomycin plus prednisone group, and prednisone group. The results showed that the improvement rate of pneumonia was higher in the minomycin plus prednisone group than in the minomycin alone group. MP infection in the prednisone alone group can spread to the central nervous system and the whole body, indicating that prednisone alone is dangerous, and glucocorticoids must be used in combination with effective anti-MP drugs. Observing the time of application of prednisone, it was found that the lesion disappearance rate was higher than that given after 3 days of infection, and the lesion disappearance rate was higher than that of 7 days after infection, so the early use of hormones was more effective than that of late use. Dosage: prednisone or prednisolone or methylprednisolone l~2mg/(kgd), or hydrocortisone succinate 5-10mg/(kgd), the course of treatment is about 7-14d.

2. Intravenous gamma globulin and other drugs

Because mycoplasma infection can lead to hyperimmunity, intravenous gamma globulin (IVIG) can be used in immune-mediated disease, so high-dose IVIG can be used as adjunctive therapy in patients with severe mycoplasma infection, extrapulmonary complications, or those with contraindications to glucocorticoids (eg, significant immunodeficiency), but should not be routinely used in patients with general mycoplasma infection. Glucocorticoids and high-dose IVIG have been reported in the literature to improve the prognosis of complications of Mycoplasma cerebral infection.Plasmapheresis has also been reported in severe cases of Mycoplasma pneumoniae central nervous system complications.

At present, there is no vaccine for Mycoplasma pneumoniae with high safety and strong protection. Non-specific immune prevention and treatment mainly uses immunosuppressants and immunomodulators, and current research focuses on cytokines. There are changes in the production of a variety of cytokines during mycoplasma infection, and the production of various cytokines is mostly distributed in a curve, which indicates that the body's own immune status also plays a great role, and simply supplementing or blocking a certain cytokine will interfere with the body's own immune response and may also aggravate the injury. For mycoplasma infection, whether and how cytokines can be used remains to be further studied.

prognosis

The prognosis is good, and although the course of the disease is sometimes prolonged, recovery is complete. Complications are rare, except for otitis media, pleural effusion, hemolytic anemia, myocarditis, pericarditis, meningoencephalitis, and mucocutaneous syndromes. However, it can occasionally recur, and sometimes pulmonary lesions and recovery of lung function are slow.