Clinical Evidence Evaluation of Syndrome-Specific Chinese Herbal Oral Liquids Combined with Azithromycin for Treating Mycoplasma Pneumoniae Pneumonia in Children

HU Mingzhi; GONG Zhaoyuan; SONG Tian; LIANG Ning; CHE Qianzi; ZHANG Haili; GUO Jing; LI Huizhen; ZHAO Guozhen; WANG Yanping; SHI Nannan; LIU Bin

Abstract：Objective To systematically evaluate the clinical efficacy and evidence quality of syndrome-specific Chinese herbal oral liquids combined with azithromycin in treating mycoplasma pneumoniae pneumonia(MPP)in children.Methods Randomized controlled trials(RCTs)on the intervention of pediatric MPP with syndrome-specific Chinese herbal oral liquids combined with azithromycin were retrieved from Chinese and international databases.After literature screening,eligible studies were systematically reviewed and meta-analyzed.Results A total of 42 studies were included,involving 3 types(6 subtypes)of syndrome-specific Chinese herbal oral liquids and 4 598 participants.Meta-analysis showed that syndrome-specific Chinese herbal oral liquids combined with azithromycin was superior to azithromycin monotherapy in improving the overall response rate[RR=1.20,95%CI(1.17,1.23),P<0.001].The oral liquid for wind-heat invading lung syndrome demonstrated significant advantages in reducing fever duration[MD=-1.71,95%CI(-1.97,-1.44),P<0.001],cough relief time[MD=-2.62,95%CI(-2.96,-2.27),P<0.001],and rales disappearance time[MD=-1.96,95%CI(-2.49,-1.43),P<0.001].The oral liquid for food accumulation syndrome also showed notable therapeutic benefits in shortening fever duration[MD=-1.73,95%CI(-2.28,-1.17),P<0.001]and rales disappearance time[MD=-2.01,95%CI(-2.64,-1.37),P<0.001].Evidence quality assessment indicated that the methodological quality of the included studies was generally low,with insufficient descriptions of allocation concealment and blinding.The GRADE system evaluation revealed that all outcome indicators were supported by low-quality evidence.Conclusion Syndrome-specific Chinese herbal oral liquids exhibit promising clinical value in treating pediatric MPP,particularly in improving symptoms of wind-heat invading lung syndrome and food accumulation syndrome.Further high-quality,multicenter,large-sample RCTs are needed to enhance the evidence reliability and provide more robust support for clinical practice.