Evidence map›Paper›PMID 41402982›Full record

Observational studyItalian journal of pediatrics2025

Doxycycline vs levofloxacin for macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a real-world study from China.

Ruling Yang, Hongmei Xu, Zhenzhen Zhang, Ruiqiu Zhao, Quanbo Liu, Mengyang Liu, Gaihuan Zheng, Xiaoying Wu

Abstract readObservational StudyComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Italian journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Doxycycline for Macrolide-ResistantInfection and drug resistance · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Ruling YangDepartment of Infectious Diseases, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, No. 136 Zhongshan Second Street, Yuzhong, Chongqing, 400014, China.
Hongmei XuDepartment of Infectious Diseases, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, No. 136 Zhongshan Second Street, Yuzhong, Chongqing, 400014, China.
Zhenzhen ZhangDepartment of Infectious Diseases, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, No. 136 Zhongshan Second Street, Yuzhong, Chongqing, 400014, China.
Ruiqiu ZhaoDepartment of Infectious Diseases, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, No. 136 Zhongshan Second Street, Yuzhong, Chongqing, 400014, China.
Quanbo LiuDepartment of Infectious Diseases, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, No. 136 Zhongshan Second Street, Yuzhong, Chongqing, 400014, China.
Mengyang LiuDepartment of Epidemiology and Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, Hebei, 050017, China.
Gaihuan ZhengDepartment of Infectious Diseases, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, No. 136 Zhongshan Second Street, Yuzhong, Chongqing, 400014, China.
Xiaoying WuDepartment of Infectious Diseases, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, No. 136 Zhongshan Second Street, Yuzhong, Chongqing, 400014, China. wuxiaoying428@163.com.ORCID http://orcid.org/0000-0001-5457-4462

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMacrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) is a growing concern in paediatrics, yet comparative data on second-line antibiotics remain limited. This study aimed to evaluate the efficacy and safety of doxycycline and levofloxacin in treating MUMPP in children.

methodsThis single-centre, real-world observational cohort study was conducted in a tertiary paediatric hospital in China. We included children hospitalised with M. pneumoniae pneumonia between July and December 2023. Patients were classified as having macrolide-sensitive M. pneumoniae pneumonia (MSMPP) or MUMPP according to their clinical response to initial azithromycin therapy. MUMPP patients were further allocated to the doxycycline, levofloxacin, or azithromycin group, based on the second-line antibiotic prescribed. Clinical characteristics, treatment outcomes, and adverse events were compared across groups. The primary outcome measures were the duration of pulmonary signs and the duration of fever after the change of antibiotic. The secondary outcome measure was the incidence of adverse events.

resultsMUMPP accounted for 66.6% (365/548) of cases. Compared with MSMPP, children with MUMPP had higher rates of tachypnoea (17.5% vs 1.6%, p < 0.001) and high-grade fever (82.2% vs 60.7%, p < 0.001).The median fever duration after second-line antibiotic treatment was 0 days (IQR 0–1) in both the doxycycline (n = 190) and levofloxacin (n = 130) groups, with no significant difference between them (p = 0.088), but both were significantly shorter than in the azithromycin group (n = 45; median 3 days, IQR 2–3; both p < 0.001). IPTW-adjusted and age-stratified (3–6 years) analyses, in which baseline characteristics were fully balanced, yielded consistent results, and showed no significant difference between the doxycycline and levofloxacin groups in defervescence rates across the four time intervals (within 24 h, 24–48 h, 48–72 h, and > 72 h), and no differences in pulmonary sign resolution among any of the three groups. No cases of tooth discolouration or musculoskeletal complications were observed, and no gastrointestinal events of GSRS grade ≥5 or other CTCAE grade ≥3 adverse events occurred in any treatment group during the treatment period.

conclusionsThis study demonstrated that both doxycycline and levofloxacin are effective and safe treatments for paediatric MUMPP. Their judicious use may also help optimise antibiotic prescribing practices and mitigate antimicrobial resistance.

Indexed as

Anti-Bacterial AgentsDoxycyclineLevofloxacinMycoplasma pneumoniaePneumonia, MycoplasmaChildChild, PreschoolChinaFemaleHumansInfantMacrolidesMaleRetrospective StudiesTreatment OutcomeAnti-Bacterial AgentsDoxycyclineLevofloxacinMacrolidesChildrenDoxycyclineLevofloxacinMycoplasma pneumoniaePneumonia

Identifiers

PMID41402982
PMCPMC12709720

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.