Abstract:

Refractory Mycoplasma pneumoniae pneumonia(RMPP) represents a special type of pediatric respiratory infection, characterized by prolonged course of disease and frequent complications. Its occurrence is related to not only the persistent existence of drug-resistant Mycoplasma pneumoniae and toxic action but also imbalanced host immune response, inflammatory cytokine storm and formation of airway mucus plug, and some child patients have multiple system organs involved. Current western medicine treatment relies mainly on antibiotics; however, the effect of macrolide is limited because of high drug resistance, while tetracyclines and fluoroquinolones are restricted by age and safety. Corticosteroids and intravenous immunoglobulin(IVIG) can improve short-term outcomes in high-inflammatory phenotypes, yet there is still no unified norms for indications, timing, dosage, and long-term safety of medication. Bronchoscopic alveolar lavage facilitates mucus clearance and ventilation improvement, but there is a lack of randomized controlled multicenter evidence. Based on the pathogenesis of "wind-heat invading the lung, phlegm-heat obstructing the lung and healthy qi deficiency with lingering pathogens", and with its therapeutic principles of "clearing heat and removing toxin, ventilating the lung and resolving phlegm and tonifying qi and strengthening healthy qi", traditional Chinese medicine(TCM) exerts multi-target anti-inflammatory and immunomodulatory effects. Clinical researches and systematic evaluation have shown that related prescriptions and Chinese patent medicines have some advantages in clearing fever, relieving symptoms and imaging absorption. The protocols combining TCM and western medicine have shown synergistic effects in shortening disease course, decreasing inflammatory load and reducing hormone use, which is expected to improve the short-term and long-term prognosis of RMPP children. This review systematically collates the pathogenesis, treatment challenges and evidence-based evidence of RMPP in western medicine, traditional Chinese medicine and integrated Chinese and western medicine, and proposes the comprehensive management ideas based on stages of disease course and phenotypic stratification, aiming to provide a reference for further optimizing therapeutic strategies and designing high-quality clinical trials.

Key words: Refractory Mycoplasma pneumoniae pneumonia, Pathogenesis, Chinese medicine, Integrated traditional Chinese and western medicine, Child