Efficacy and Safety of Integrated Maxing Shigan Decoction and Azithromycin for Mycoplasma Pneumoniae Pneumonia in Children: A Systematic Review and Meta-Analysis

Background. The primary objective of this study was to thoroughly assess the effectiveness of treating pediatric mycoplasma pneumoniae pneumonia (MPP) with Maxing Shigan decoction (MSD) and azithromycin. Materials and Methods. We comprehensively reviewed the literature for randomized controlled trials research on MPP treated by MSD combined with azithromycin in children in the databases of Medicine, Embase, ClinicalTrials.gov, Cochrane Library, PubMed, CNKI, WangFang, and VIP from inception to April 2021. dds ratio (OR) was used for dichotomous data, while the mean difference (MD) was adopted for continuous variables as effect size, both of which were demonstrated in effect size and 95% confidence intervals (CI). Results. A total of 49 studies with 5704 patients were included in the meta-analysis. The results showed that MSD combined with azithromycin significantly improved the clinical efficacy (OR = 5.31, 95% CI: (4.35, 6.49), and $p<0.001$ ) and reduced the chest X-rays recovery time (MD = −2.25, 95% CI: (−2.86, −1.65), and $p<0.001$ ), cough duration (MD = −2.53, 95% CI: (−2.93. −2.12), and $p<0.001$ ), CRP (MD = −7.84, 95% CI: (−9.51, −6.17), and $p<0.001$ ), fever duration (MD = −1.53, 95% CI: (−1.78, −1.28), and $p<0.001$ ), hospital days (MD = −2.70, 95% CI: (−3.35, −2.06), and $p<0.001$ ), moist rales duration (MD = −2.00, 95% CI: (−2.33, −1.68), and $p<0.001$ ), and adverse effects (OR = 0.55, 95% CI: (0.41, 0.75), and $p<0.001$ ) when compared with azithromycin alone in the treatment of MPP in children. Meta-regression analysis demonstrated that the course of disease and duration of medication contribute to the heterogeneity across studies when comparing outcomes between groups. Conclusion. MSD and azithromycin worked better when used in conjunction to treat MPP in young patients. These findings require confirmation by additional high-quality, big sample RCTs.