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

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.