Abstract
BACKGROUND: Mycoplasma pneumoniae pneumonia (MPP) is a common pediatric respiratory infection that can lead to serious complications. Increasing macrolide resistance and limited efficacy of antibiotic monotherapy necessitate exploration of adjunctive treatment strategies. METHODS: This single-center retrospective, non-randomized cohort study included 140 children diagnosed with MPP between January 2020 and February 2022. Patients received either azithromycin sequential therapy alone (control group, n = 70) or IVIG plus azithromycin (IVIG group, n = 70). Baseline characteristics were comparable between groups; however, disease severity was not formally stratified. Outcomes included clinical efficacy, time to symptom resolution, inflammatory cytokines (IL-6, TNF, IL-2), immunoglobulin levels (IgG, IgA, IgM), pulmonary function, and adverse events. Multivariable logistic regression was used to adjust for baseline covariates. RESULTS: The total effective rate was higher in the IVIG group than in the control group (97.14% vs. 84.29%, p < 0.05). Time to fever resolution, cough disappearance, wet rales resolution, and radiographic absorption was shorter in the IVIG group (all p < 0.01). IL-6 and TNF decreased and IL-2 increased in both groups, with greater changes in the IVIG group (p < 0.05). Post-treatment immunoglobulin levels and pulmonary function were higher in the IVIG group. In adjusted analysis, IVIG treatment was associated with a higher likelihood of clinical response (adjusted OR 5.82, 95% CI 1.22-27.74, p = 0.028). Adverse events were low and comparable between groups (p > 0.05). CONCLUSION: Adjunctive IVIG combined with azithromycin was associated with improved clinical and laboratory outcomes in children with MPP without increasing adverse events. Findings should be interpreted cautiously due to the retrospective design and potential residual confounding.