多西环素在治疗儿童百日咳中的疗效与安全性

何雨暄; 王华平; 赵仕勇; 詹璐

doi:10.16766/j.cnki.issn.1674-4152.004372

多西环素在治疗儿童百日咳中的疗效与安全性

doi: 10.16766/j.cnki.issn.1674-4152.004372

1.
浙江中医药大学第二临床医学院，浙江杭州 310053
2.
杭州市儿童医院感染肝病科，浙江杭州 310014
3.
浙江省中西医结合医院儿科，浙江杭州 310005

基金项目:

浙江省医药卫生科技计划项目 2023KY202

详细信息

通讯作者:
詹璐，E-mail: zlhz2003@126.com

中图分类号: R516.6
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- 文章访问数: 6
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- 被引次数: 0
出版历程
- 收稿日期: 2025-03-29
- 网络出版日期: 2026-04-11

Clinical efficacy and safety of doxycycline in pediatric pertussis

1.
Zhejiang Chinese Medical University, the Second School of Clinical Medicine, Hangzhou, Zhejiang 310053, China

摘要

摘要: 目的探讨多西环素在8岁及以上儿童百日咳临床治疗中的有效性与安全性。方法回顾性分析2023年12月—2024年5月于浙江省中西医结合医院儿科门诊就诊的166例8岁及以上百日咳患儿，根据抗生素选择的不同分为阿奇霉素组(62例)，复方磺胺甲噁唑(TMP-SMZ)组(48例)和多西环素组(56例)，比较3组治疗效果、症状缓解时间及不良反应发生率等。结果阿奇霉素组显效9例，有效11例，无效42例，总有效率为32.25%；TMP-SMZ组显效14例，有效26例，无效8例，总有效率为83.33%；多西环素组显效18例，有效26例，无效12例，总有效率为78.57%。阿奇霉素组总有效率低于其余2组(Bonferroni校正后P＜0.001)。阿奇霉素组、TMP-SMZ组、多西环素组症状缓解时间分别为(13.05±4.23)d、(11.00±2.30)d、(11.23±2.59)d，阿奇霉素组长于其余2组(P < 0.05)。不良反应方面，阿奇霉素组和多西环素组分别有11例、5例患儿出现消化道症状；TMP-SMZ组共14例患儿出现不良反应，其中4例为消化道症状，10例为皮疹，其皮疹、总不良反应发生率均高于多西环素组(Bonferroni校正后P < 0.017)。结论多西环素能有效缓解8岁及以上百日咳患儿症状，且不良反应较少，具有一定的临床应用价值。
- 百日咳 /
- 儿童 /
- 多西环素
Abstract: Objective To explore the efficacy and safety of doxycycline in treating pertussis in children aged 8 years and above. Methods A retrospective analysis was conducted on 166 children aged ≥ 8 years with pertussis who attended the pediatric outpatient department of Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine from December 2023 to May 2024. According to the antibiotics selected, patients were divided into the azithromycin group (62 cases), the trimethoprim sulfamethoxazole (TMP-SMZ) group (48 cases), and the doxycycline group (56 cases). The clinical efficacy, time to symptom relief, and incidence of adverse reactions were compared among the three groups. Results The azithromycin group showed 9 cases of significant effectiveness, 11 cases of effectiveness, and 42 cases of ineffectiveness, with a total effective rate of 32.25%. The TMP-SMZ group demonstrated 14 cases of significant effectiveness, 26 cases of effectiveness, and 8 cases of ineffectiveness, yielding a total effective rate of 83.33%. In the doxycycline group, 18 cases were significantly effective, 26 cases were effective, and 12 cases were ineffective, with a total effective rate of 78.57%. The total effective rate of the azithromycin group was lower than that of the other two groups (P < 0.001 after Bonferroni correction). The times to symptom relief time in the azithromycin, TMP-SMZ, and doxycycline groups were (13.05±4.23) days, (11.00±2.30) days, and (11.23±2.59) days, respectively, with the azithromycin group showing a significantly longer duration (P < 0.05). In terms of adverse reactions, 11 cases in the azithromycin group and 5 cases in the doxycycline group had gastrointestinal symptoms. In the TMP-SMZ group, 14 patients developed adverse reactions, including 4 with gastrointestinal symptoms and 10 with rashes. The TMP-SMZ group had higher incidences of rash and total adverse reactions compared to the doxycycline group (P < 0.017 after Bonferroni correction). Conclusion Doxycycline can effectively alleviate symptoms in children aged 8 years and older with pertussis, with fewer adverse reactions, supporting its clinical application value.
- Pertussis /
- Children /
- Doxycycline

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表 1 3组百日咳患儿一般情况比较

Table 1. Comparison of general characteristics among three groups of enrolled pertussis patients

组别	例数	年龄[M(P₂₅, P₇₅)，岁]	性别[例(%)]		初诊前病程[M(P₂₅, P₇₅)，d]	CET评分[M(P₂₅, P₇₅)，分]	肺部影像学阳性[例(%)]
组别	例数	年龄[M(P₂₅, P₇₅)，岁]	男	女	初诊前病程[M(P₂₅, P₇₅)，d]	CET评分[M(P₂₅, P₇₅)，分]	肺部影像学阳性[例(%)]
阿奇霉素组	62	9.50(8.00, 11.00)	32(51.61)	30(48.39)	4.00(3.00, 6.00)	17.00(16.00, 19.25)	7(11.29)
TMP-SMZ组	48	9.00(8.00, 10.75)	20(41.67)	28(58.33)	3.00(2.00, 5.00)	18.00(17.00, 21.00)	4(8.33)
多西环素组	56	9.00(8.25, 10.75)	31(55.36)	25(44.64)	3.50(2.00, 5.00)	18.00(17.00, 20.00)	7(12.50)
统计量		0.611^a	2.041^b		4.211^a	3.673^a	0.485^b
P值		0.737	0.360		0.122	0.159	0.785
注：^a为H值，^b为χ²值。

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表 2 3组百日咳患儿治疗效果比较[例(%)]

Table 2. Comparison of therapeutic effects among three groups of enrolled pertussis patients [cases (%)]

组别	例数	显效	有效	无效	总有效
阿奇霉素组	62	9(14.52)	11(17.74)	42(67.74)	20(32.25)
TMP-SMZ组	48	14(29.17)	26(54.17)	8(16.67)	40(83.33)^a
多西环素组	56	18(32.14)	26(46.43)	12(21.43)	44(78.57)^a
χ²值					39.316
P值					< 0.001
注：与阿奇霉素组比较，^aP＜0.001。

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表 3 3组百日咳患儿临床症状缓解时间比较(x±s，d)

Table 3. Comparison of clinical symptom relief time among three groups of enrolled pertussis patients (x±s, d)

组别	例数	症状缓解时间
阿奇霉素组	20	13.05±4.23
TMP-SMZ组	40	11.00±2.30^a
多西环素组	44	11.23±2.59^a
F值		3.719
P值		0.028
注：与阿奇霉素组比较，^aP < 0.05。

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表 4 3组百日咳患儿药物不良反应发生率比较[例(%)]

Table 4. Comparison of adverse drug reactions rate among three groups of enrolled pertussis patients [cases (%)]

组别	例数	消化道症状	皮疹	合计
阿奇霉素组	62	11(17.74)	0^a	11(17.74)
TMP-SMZ组	48	4(8.33)	10(20.83)	14(29.16)
多西环素组	56	5(8.93)	0^a	5(8.93)^a
χ²值		2.454	26.159	7.157
P值		0.293	＜0.001	0.028
注：与TMP-SMZ组比较，^aP＜0.017。

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