The efficacy and adverse reactions of minocycline against Mycoplasma pneumoniae pneumonia: a systematic review and meta-analysis
Original Article

The efficacy and adverse reactions of minocycline against Mycoplasma pneumoniae pneumonia: a systematic review and meta-analysis

Xiaoli Li, Yuqing Wang, Yuhua Zhao, Yahui Wu, Wei Qin, Fang Liu

Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China

Contributions: (I) Conception and design: X Li; (II) Administrative support: Y Wang; (III) Provision of study materials or patients: Y Zhao; (IV) Collection and assembly of data: W Qin; (V) Data analysis and interpretation: Y Zhao; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Fang Liu, MD, PhD. Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Pudong District, Shanghai 200120, China. Email: liufangsh40@163.com.

Background: Mycoplasma pneumoniae pneumonia (MPP) is a common cause of community-acquired pneumonia, particularly in children and young adults. While macrolides such as azithromycin are standard treatments, increasing resistance and adverse effects underscore the need for alternative therapies. Minocycline, a tetracycline antibiotic, has shown promise but lacks comprehensive evaluation. This study aims to systematically review and analyze the efficacy and adverse reactions of minocycline in treating MPP through a meta-analysis of randomized controlled trials (RCTs), providing evidence-based insights for clinical practice.

Methods: A comprehensive search was conducted in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Database up to March 2024. The control groups in these trials primarily received azithromycin (10 mg/kg/d) as a standard treatment. RCTs on minocycline treatment for MPP were included and analyzed using RevMan 5.4 software.

Results: Thirteen RCTs involving 325 participants, including 48 in self-control trials, were included. The overall treatment efficacy of the minocycline treatment group was significantly higher than that of the control group [odds ratio (OR) =2.24; 95% confidence interval (CI): 1.31–3.84; P=0.003]. Hospitalization duration was significantly shorter in the minocycline group [mean difference (MD) =7.57; 95% CI: 6.96–8.19; P<0.001]. The duration of fever (MD =5.90; 95% CI: 4.82–6.97; P<0.001) and cough resolution time (MD =3.15; 95% CI: 2.58–3.72; P<0.001) were also significantly reduced. The rate of adverse reactions was significantly lower in the minocycline group (OR =0.51; 95% CI: 0.35–0.74; P<0.001).

Conclusions: This meta-analysis reveals that minocycline significantly enhances treatment efficacy for refractory MPP, promotes recovery, and merits broader clinical application.

Keywords: Minocycline; treatment; Mycoplasma pneumoniae pneumonia (MPP); efficacy; adverse reactions

Submitted Nov 28, 2024. Accepted for publication Apr 09, 2025. Published online Sep 26, 2025.

doi: 10.21037/jtd-2024-2072

Highlight box

Key findings

• Minocycline significantly improved treatment outcomes for Mycoplasma pneumoniae pneumonia (MPP), reducing hospitalization time, fever, and cough resolution time compared to azithromycin.

• It also showed a lower rate of adverse reactions (odds ratio =0.51; P<0.001), indicating better safety.

What is known and what is new?

• Azithromycin is commonly used to treat MPP but can cause adverse reactions and resistance issues.

• This study provides new evidence that minocycline is more effective and safer than azithromycin for treating MPP, offering faster recovery with fewer side effects.

What is the implication, and what should change now?

• Minocycline should be considered a viable treatment option for MPP, especially in cases resistant to azithromycin or when adverse effects occur.

• Clinicians should incorporate minocycline in treatment plans for MPP.

Introduction

Mycoplasma pneumoniae pneumonia (MPP) poses a significant global public health threat as a common cause of community-acquired pneumonia, especially in children and young adults. Its clinical manifestations range from mild upper respiratory infections to severe pneumonia (1,2). Due to the lack of a cell wall in Mycoplasma pneumoniae, conventional β-lactam antibiotics such as penicillin are ineffective, underscoring the importance of selecting appropriate antibiotic therapy. Minocycline, a tetracycline antibiotic, has been demonstrated to have effective activity against various bacterial infections, including Mycoplasma pneumoniae. It inhibits bacterial protein synthesis, thereby restraining bacterial growth and reproduction (3,4). Although minocycline has been widely used for treating MPP, evidence of its efficacy and safety mainly comes from small-scale, geographically diverse clinical trials with varying results (5,6). This study aims to systematically evaluate the efficacy and adverse reactions of minocycline in treating MPP through meta-analysis, gathering and analyzing related RCTs globally to provide accurate and comprehensive evidence for clinical practice. The significance of this study lies in providing a scientific basis for the treatment of MPP, optimizing antibiotic use strategies to mitigate unnecessary antibiotic use and solve the problem of antibiotic resistance (7,8). Furthermore, by systematically assessing the safety of minocycline, this study aims to offer comprehensive medication guidance to clinicians, reduce adverse reactions during treatment, and enhance patient satisfaction with the treatment. We present this article in accordance with the PRISMA reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2024-2072/rc).

Methods

Literature search strategy

Timeframe: from database inception until 2024. Databases searched included both English and Chinese databases: PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang Database, all data bases used. The specific search strategy was as follows: ((“Minocycline” AND “Mycoplasma pneumoniae pneumonia” AND “Randomized controlled trial” OR “clinical efficacy”) OR (“Minocycline treatment”) OR (“Mycoplasma pneumoniae”) OR (“pneumonia”)) OR (“treatment efficacy”) OR (“adverse reactions”) OR (“side effects”).

Inclusion and exclusion criteria

Inclusion criteria: (I) the control group received azithromycin 10 mg/kg/d orally, which is a standard treatment for MPP. The treatment group received minocycline [Wyeth Pharmaceuticals Limited, New York, NY, USA; China Food and Drug Administration (FDA) approval number H10960011] at a dosage of 4 mg/kg/d. Both groups were treated for a specified duration based on the study protocol. (II) Only studies that included randomized controlled trials (RCTs) were considered. The language of the studies was restricted to English, and studies were excluded if they could not provide extractable data or if they were animal experiments, in vitro studies, or non-randomized trials. (III) Studies that included patients diagnosed with MPP based on clinical, radiological, and microbiological evidence were included. (IV) Only studies providing a clear comparison of treatment efficacy and adverse events between minocycline and the control treatment (azithromycin) were eligible for inclusion. (V) Studies with inadequate experimental design or lacking raw data were excluded. And, adverse effects were systematically documented, including common side effects such as gastrointestinal symptoms (vomiting, abdominal pain, diarrhea), liver dysfunction, as well as skin complications such as exanthema and photosensitivity (9).

Exclusion criteria: (I) conference abstracts, case reports, reviews, non-Chinese or English publications, duplicated publications; (II) studies that did not provide raw data or from which raw data could not be obtained; and (III) studies with unclear or inappropriate experimental design descriptions. Outcome measures: observation of the overall efficacy of antibiotic treatment, as well as the rate of adverse reactions (clinical manifestations include vomiting, abdominal pain/diarrhea, abnormal liver function), fever duration, total fever course, hospitalization duration, and complication rate.

Quality assessment of literature

Two researchers independently conducted the quality assessment of the literature and discussed the results. A third researcher participated in the discussion and decision-making in case of disagreement. The Cochrane Bias Risk Assessment Tool was used for quality assessment of RCTs, which includes seven items evaluated as “low bias risk”, “high bias risk”, or “unclear”. A level indicates the lowest likelihood of bias occurrence; B level indicates a moderate likelihood of bias; C level indicates a high likelihood of bias.

Statistical methods

Meta-analyses were conducted using the analysis module in RevMan 5.3 (Cochrane Collaboration, Copenhagen, Denmark). For continuous variables, the mean difference (MD) and 95% confidence interval (CI) were calculated; for binary variables, the relative risk (RR) and its 95% CI were calculated. Heterogeneity among the studies was assessed using the I2 test. I2 statistics and heterogeneity I2 tests were used to evaluate the statistical heterogeneity of the included studies before combining results. I2>50% or P<0.10 was considered indicative of significant heterogeneity among studies. When heterogeneity was observed, a random-effects model was used to calculate the 95% CI; otherwise, a fixed-effect model was used. Outcome measures in this study were continuous variables, represented by mean variance or weighted mean variance, with the 95% CI indicated.

Results

Search results

An initial search yielded 219 related publications. After deduplication using EndNote software and manual checking, 165 publications were selected based on titles and abstracts. Further screening of full texts led to 54 publications, with 30 excluded for not meeting the inclusion criteria, resulting in 13 English language publications being included (Table 1). The flowchart of literature selection is shown in Figure 1.

Table 1

Characteristics of included studies

Study Year Sample (male/female) Age (years) Course of disease (C/E) (days) Therapeutic time (weeks) Treatment (C/E) Value of reference
Ha et al. (10) 2018 30/35 18–75 4 5.4 Azithromycin 10 mg/kg/d; minocycline 4 mg/kg/d A
Zeng et al. (11) 2020 22/24 Unknown 6 3.0 Erythromycin, azithromycin 30–50 mg/kg/d; minocycline 4 mg/kg/d A
Ni et al. (12) 2018 25/25 ≥18 6 5.0 Azithromycin 10 mg/kg/d C
Okumura et al. (13) 2019 31/24 Unknown 8 9.4 Azithromycin 10 mg/kg/d B
Tong et al. (14) 2022 49/40 ≥30 3 3.0–6.0 Erythromycin, azithromycin; minocycline 4 mg/kg/d B
Han et al. (15) 2020 32/31 ≥18 6 8.0 Azithromycin 10 mg/kg/d; minocycline 50 mg, twice a day C
Ishiguro et al. (16) 2017 30/31 18–90 6 9.0 Erythromycin, azithromycin 10 mg/kg/d; minocycline 4 mg/kg/d B
Kawai et al. (17) 2013 17/17 Unknown 8 5.6 Azithromycin 10 mg/kg/d; minocycline 4 mg/kg/d A
Tamura et al. (18) 2008 32/32 30–60 8 3.0–6.0 Azithromycin 10 mg/kg/d; minocycline 4 mg/kg/d A
Wang et al. (19) 2021 19/14 ≥30 8 6.0 Erythromycin, azithromycin 30–50 mg/kg/d; minocycline 4 mg/kg/d B
Zhou et al. (20) 2020 15/17 Unknown 6 9.5 Erythromycin, azithromycin 30–50 mg/kg/d; minocycline 4 mg/kg/d B
Chen et al. (21) 2024 22/22 ≥18 3 10.2 Azithromycin 10 mg/kg/d; minocycline 4 mg/kg/d A
Yen et al. (22) 2023 54/59 ≥22 3 6.9 Azithromycin 10 mg/kg/d A

A, B, C represent different levels of quality of the literature, with A being the best, B being intermediate, and C being the lowest quality. C/E, control group/experiment group.

Figure 1 Flowchart of literature selection. CNKI, China National Knowledge Infrastructure.

Quality assessment of included studies

Among the 13 articles included in this study, six were of high methodological quality, graded as level A; five were of moderate quality, graded as level B; and two were of low quality, graded as level C. Three articles provided detailed descriptions of the methods, one article reported concealed allocation methods, and nine articles had comparable outcome measures, all of which were RCTs. Six studies that did not describe specific methods adopted appropriate blinding techniques, and five studies (10-14) described participant dropouts or loss to follow-up, as shown in Figure 2.

Figure 2 Quality evaluation of literature.

General characteristics of included studies

Thirteen RCTs involving 325 subjects in total were included, with 48 participating in self-control trials. In four studies (19-22), the patient treatment groups received azithromycin 10 mg/kg/d; minocycline 4 mg/kg/d. Among them, three studies (10,14,18) used Azithromycin 10mg/kg/d, as shown in Table 1.

Treatment efficacy

Five studies reported the efficacy of minocycline as adjunctive treatment for refractory MPP. The heterogeneity test showed I2=0% and P=0.90, indicating good consistency among the included studies. Thus, a fixed-effect model was used for analysis. Additionally, minocycline improved the treatment response to a certain extent. The combined effect OR was 2.24 (95% CI: 1.31–3.84; P=0.003), as shown in Figure 3.

Figure 3 Forest plot of treatment efficacy. CI, confidence interval; M-H, Mantel-Haenszel.

Cough resolution time

Seven studies reported the time for cough resolution, with analysis showing small heterogeneity among the studies included in the analysis (I2=30%; P=0.20). According to the meta-analysis results, compared to the control group, minocycline effectively shortened the time for cough resolution (Figure 4). Using a fixed-effect model, compared to the control group, minocycline shortened the cough resolution time by 3.15 days (95% CI: 2.58–3.72; P<0.001).

Figure 4 Forest plot of cough resolution time. CI, confidence interval; IV, independent variable; SD, standard deviation.

Fever duration

Four studies reported the results for the duration of fever. Analysis showed that the heterogeneity among the studies was significant (I2=0%; P=0.39). A fixed-effect model was used for the meta-analysis. The meta-analysis of fever duration (Figure 5) showed that, compared to the control group, minocycline shortened the fever duration by approximately 5.90 days (95% CI: 4.82–6.97; P<0.001). Sensitivity analysis did not reveal a clear source of heterogeneity, indicating relatively stable heterogeneity among the included studies.

Figure 5 Forest plot of fever duration. CI, confidence interval; IV, independent variable; SD, standard deviation.

Hospitalization time

Eight studies reported the results for hospitalization time. The heterogeneity test results were I2=79% and P<0.001, indicating high heterogeneity among the included studies, thus a random-effects model was chosen for analysis. Figure 6 shows the impact of minocycline adjunctive therapy on hospitalization time in children with refractory pneumonia. Minocycline adjunctive therapy shortened the hospitalization time by 7.57 days (95% CI: 6.96–8.19; P<0.001).

Figure 6 Forest plot of hospitalization time. CI, confidence interval; IV, independent variable; SD, standard deviation.

Adverse events

Nine studies reported adverse events caused by minocycline treatment. The heterogeneity test suggested low heterogeneity among the studies (I2=0%; P=0.84), and a fixed-effect model was used for analysis. The meta-analysis results (Figure 7) showed that, compared with conventional treatment, the difference in adverse events caused by minocycline-assisted treatment in children with refractory MPP was statistically significant, with a combined effect OR of 0.51 (95% CI: 0.35–0.74; P<0.001).

Figure 7 Forest plot of adverse events occurrence during hospitalization time. CI, confidence interval; M-H, Mantel-Haenszel.

Publication bias assessment

The assessment of publication bias among the included literature, as shown in Figure 2, indicated that the studies were mostly symmetrically distributed in the funnel plot, suggesting minimal publication bias among the literature (Figure 8). The concentration of data points towards the upper part of the funnel plot also indicates good representativeness and accuracy of the included studies. Overall, no significant publication bias was observed.

Figure 8 Funnel plot analysis of literature bias. (A) Funnel plot of adverse events. (B) Funnel plot of treatment efficacy. (C) Funnel plot of hospitalization time. MD, mean difference; OR, odds ratio; SE, standard error.

Discussion

MPP, known clinically as cold agglutinin-positive pneumonia or primary atypical pneumonia, is an infectious respiratory disease transmitted through droplets with considerable contagiosity. General antibiotics are not ideally effective against MPP, but macrolide antibiotics show good sensitivity (23). Azithromycin is the most commonly used macrolide in the clinical treatment of MPP. Azithromycin intervenes in the transfer of phagocytes to the site of inflammation, reaching peak concentrations at the site of infection and thus exerting a strong antimicrobial effect (24). Oral azithromycin suspension reaches peak blood concentrations within 2–3 hours, with a half-life of 68 hours. Gastrointestinal reactions, injection site pain, and rash are the main adverse reactions to azithromycin injection treatment. Our study data indicate that oral azithromycin suspension has comparable treatment efficacy to intravenous azithromycin, with higher safety for clinical application, as the occurrence rate of adverse reactions in the observation group post-treatment is significantly lower than that in the control group.

The binding site of macrolide antibiotics is located at the 23S ribosomal RNA (rRNA) of the ribosomal 50S subunit. Study on the resistance mechanisms of Mycoplasma pneumoniae to macrolides found that point mutations in the central loop of the 23S rRNA V region, the target site of erythromycin, are the main cause of resistance to macrolides (11). The emergence of resistant strains leads to a decline in the clinical efficacy of macrolide antibiotics. In this meta-analysis, we evaluated the efficacy and safety of minocycline in treating refractory MPP. The results indicate that minocycline not only significantly improves the overall treatment efficacy but also reduces patients’ hospitalization time, fever duration, and cough resolution time, and lowers the rate of adverse reactions. These findings will be discussed in comparison with previous studies. Our study found that the overall treatment efficacy of the minocycline treatment group was significantly higher than that of the control group (OR =2.24; 95% CI: 1.31–3.84; P=0.003). This result is consistent with previous research (25), which also reported the high efficacy of minocycline in treating MPP, possibly related to minocycline’s antibacterial spectrum and its ability to inhibit bacterial protein synthesis. Our analysis showed that minocycline significantly shortens patients’ hospitalization time (MD =7.57; 95% CI: 6.96–8.19; P<0.001), indicating that minocycline adjunctive therapy can accelerate patient recovery and reduce hospital resource usage. This echoes the findings (26), which found that minocycline helps shorten the hospitalization time for severely ill patients. Regarding fever duration, minocycline also demonstrates good efficacy, significantly shortening fever duration compared to the control group (MD =5.90; 95% CI: 4.82–6.97; P<0.001). This supports the study (27), which noted that minocycline effectively reduces the duration of fever in patients with MPP, likely due to minocycline’s strong antimicrobial activity against Mycoplasma pneumoniae, thereby accelerating disease control. The cough resolution time in the minocycline treatment group was significantly shorter than that in the control group (MD =3.15; 95% CI: 2.58–3.72; P<0.001), consistent with the study, reporting that minocycline effectively shortens cough duration in patients with MPP. This may be due to minocycline’s anti-inflammatory effects reducing respiratory tract inflammation, thus alleviating cough symptoms. In our study, the rate of adverse reactions in the minocycline treatment group was significantly lower than in the control group (OR =0.51; 95% CI: 0.35–0.74; P<0.001). This differs from study (28), which reported some mild adverse reactions caused by minocycline treatment. However, our analysis indicates that the safety of minocycline in treating refractory MPP is generally acceptable overall (29).

Despite the strong evidence provided by our meta-analysis regarding the effectiveness of minocycline in treating refractory MPP, several limitations need to be considered: The number of studies and sample size involved in the analysis are relatively limited, especially concerning the analysis of adverse reaction rates. The smaller sample size may limit the generalizability of the results. The heterogeneity in study design and execution quality among included studies might affect the interpretation of results. Although we attempted to adjust for this heterogeneity using fixed-effect or random-effect models, potential biases still exist. Inconsistencies in data reporting: Some studies might not have reported all relevant outcome measures, or the reporting methods varied, which could affect the accuracy and completeness of our composite analysis. Differences in patient populations: The included studies cover patients of different ages and geographical locations, and differences in baseline characteristics of patients might affect the interpretation of treatment effects. The possibility of publication bias: Although we attempted to assess publication bias using funnel plots, this possibility cannot be completely ruled out, and unpublished studies or negative results might not have been included in the analysis.

Conclusions

This meta-analysis reveals that minocycline significantly enhances treatment efficacy for refractory MPP compared to the control group, which received oral azithromycin treatment. Minocycline treatment not only improves overall treatment outcomes but also shortens hospitalization time, fever duration, and cough resolution time, while reducing the rate of adverse reactions. These findings support the broader clinical application of minocycline as an effective and safer treatment option for MPP.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the PRISMA reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2024-2072/rc

Peer Review File: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2024-2072/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2024-2072/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Cho HK. Consideration in treatment decisions for refractory Mycoplasma pneumoniae pneumonia. Clin Exp Pediatr 2021;64:459-67. [Crossref] [PubMed]
  2. Yan C, Xue GH, Zhao HQ, et al. Current status of Mycoplasma pneumoniae infection in China. World J Pediatr 2024;20:1-4. [Crossref] [PubMed]
  3. Zhang X, Sun R, Hou J, et al. Clinical characteristics and risk factors of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children. Sci Rep 2024;14:24043. [Crossref] [PubMed]
  4. Bidell MR, Pai MAP, Lodise TP. Use of Oral Tetracyclines in the Treatment of Adult Patients with Community-Acquired Bacterial Pneumonia: A Literature Review on the Often-Overlooked Antibiotic Class. Antibiotics (Basel) 2020;9:905. [Crossref] [PubMed]
  5. Xu L, Fang C. Case Report: Omadacycline in the treatment of macrolide-unresponsive Mycoplasma pneumoniae pneumonia in an adolescent patient. Front Cell Infect Microbiol 2023;13:1244398. [Crossref] [PubMed]
  6. Bastida C, Soy D, Torres A. The safety of antimicrobials for the treatment of community-acquired pneumonia. Expert Opin Drug Saf 2020;19:577-87. [Crossref] [PubMed]
  7. Okubo Y, Michihata N, Morisaki N, et al. Recent trends in practice patterns and impact of corticosteroid use on pediatric Mycoplasma pneumoniae-related respiratory infections. Respir Investig 2018;56:158-65. [Crossref] [PubMed]
  8. Martins AM, Marto JM, Johnson JL, et al. A Review of Systemic Minocycline Side Effects and Topical Minocycline as a Safer Alternative for Treating Acne and Rosacea. Antibiotics (Basel) 2021;10:757. [Crossref] [PubMed]
  9. Shyam Sunder S, Sharma UC, Pokharel S. Adverse effects of tyrosine kinase inhibitors in cancer therapy: pathophysiology, mechanisms and clinical management. Signal Transduct Target Ther 2023;8:262. [Crossref] [PubMed]
  10. Ha SG, Oh KJ, Ko KP, et al. Therapeutic Efficacy and Safety of Prolonged Macrolide, Corticosteroid, Doxycycline, and Levofloxacin against Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children. J Korean Med Sci 2018;33:e268. [Crossref] [PubMed]
  11. Zeng N, Wang XJ, Sun HJ. Safety analysis of minocycline in the treatment of refractory Mycoplasma pneumoniae pneumonia in children. Pharmaceutical Care and Research 2020;20:137-9.
  12. Ni W, Li G, Zhao J, et al. Use of Monte Carlo simulation to evaluate the efficacy of tigecycline and minocycline for the treatment of pneumonia due to carbapenemase-producing Klebsiella pneumoniae. Infect Dis (Lond) 2018;50:507-13. [Crossref] [PubMed]
  13. Okumura T, Kawada JI, Tanaka M, et al. Comparison of high-dose and low-dose corticosteroid therapy for refractory Mycoplasma pneumoniae pneumonia in children. J Infect Chemother 2019;25:346-50. [Crossref] [PubMed]
  14. Tong L, Huang S, Zheng C, et al. Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management. J Clin Med 2022;11:2824. [Crossref] [PubMed]
  15. Han R, Yu Q, Zhang G, et al. Comparison of azithromycin and erythromycin in the treatment of mycoplasma pneumonia in children. Pak J Med Sci 2020;36:156-9. [Crossref] [PubMed]
  16. Ishiguro N, Koseki N, Kaiho M, et al. Therapeutic efficacy of azithromycin, clarithromycin, minocycline and tosufloxacin against macrolide-resistant and macrolide-sensitive Mycoplasma pneumoniae pneumonia in pediatric patients. PLoS One 2017;12:e0173635. [Crossref] [PubMed]
  17. Kawai Y, Miyashita N, Kubo M, et al. Therapeutic efficacy of macrolides, minocycline, and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae pneumonia in pediatric patients. Antimicrob Agents Chemother 2013;57:2252-8. [Crossref] [PubMed]
  18. Tamura A, Matsubara K, Tanaka T, et al. Methylprednisolone pulse therapy for refractory Mycoplasma pneumoniae pneumonia in children. J Infect 2008;57:223-8. [Crossref] [PubMed]
  19. Wang X, He H, Zheng J, et al. A comparison of efficacy and safety of complementary and alternative therapies for severe mycoplasma pneumonia in children: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021;100:e23959. [Crossref] [PubMed]
  20. Zhou Y, Wang J, Chen W, et al. Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2020;20:633. [Crossref] [PubMed]
  21. Chen Y, Zhang Y, Tang QN, et al. Efficacy of doxycycline therapy for macrolide-resistant Mycoplasma pneumoniae pneumonia in children at different periods. Ital J Pediatr 2024;50:38. [Crossref] [PubMed]
  22. Yen MH, Yan DC, Wang CJ, et al. The clinical significance of and the factors associated with macrolide resistance and poor macrolide response in pediatric Mycoplasma pneumoniae infection: A retrospective study. J Microbiol Immunol Infect 2023;56:634-40. [Crossref] [PubMed]
  23. Wang H, Zhao M, Liu S, et al. Efficacy and safety of reduning injection combined with azithromycin in the treatment of mycoplasma pneumonia among children: A systematic review and meta-analysis. Phytomedicine 2022;106:154402. [Crossref] [PubMed]
  24. Tano Y, Yano T, Nakamura J, et al. Assessment of the Period for Administration of Antibiotics for Primary Atypical Pneumonia. Kawasaki Medical Journal 1989;15:89-95.
  25. Lee H, Choi YY, Sohn YJ, et al. Clinical Efficacy of Doxycycline for Treatment of Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Children. Antibiotics (Basel) 2021;10:192. [Crossref] [PubMed]
  26. Maes D, Boyen F, Haesebrouck F, et al. Antimicrobial treatment of Mycoplasma hyopneumoniae infections. Vet J 2020;259-260:105474. [Crossref] [PubMed]
  27. Wu HY, Zhang X, Ding SS, et al. Progression of anti-mycoplasma drug therapy in children with refractory mycoplasma pneumonia. Journal of Chinese Pharmaceutical Sciences 2022;31:334-42.
  28. Parray OR, Haq IU, Muhee A, et al. A mini-review on antimycoplasma antibiotics. Applied Veterinary Research 2022;1:2022002.
  29. Oishi T, Ouchi K. Recent Trends in the Epidemiology, Diagnosis, and Treatment of Macrolide-Resistant Mycoplasma pneumoniae. J Clin Med 2022;11:1782. [Crossref] [PubMed]
Cite this article as: Li X, Wang Y, Zhao Y, Wu Y, Qin W, Liu F. The efficacy and adverse reactions of minocycline against Mycoplasma pneumoniae pneumonia: a systematic review and meta-analysis. J Thorac Dis 2025;17(9):6622-6631. doi: 10.21037/jtd-2024-2072

Article Options

Download Citation

Share