{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:08:42Z","timestamp":1775660922479,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Mycoplasma pneumoniae pneumonia (MPP) in children is a common respiratory infection, with rising concerns over macrolide-resistant strains. The aim of this study is to establish an effective diagnostic prediction model for refractory MPP (RMPP) and evaluate doxycycline as an alternative treatment for macrolide-unresponsive MPP (MUMPP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>106 children with RMPP receiving doxycycline and 73 children with MUMPP treated with azithromycin were retrospectively analyzed. For all patients, the detection of MP-DNA in BALF, alongside clinical criteria, served to confirm active MP infection and infer phenotypic macrolide unresponsiveness\/resistance. Univariate and multivariate logistic regression analyses were then used to identify clinically available risk factors for the development of RMPP among these patients with MP pneumonia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The doxycycline group had significantly shorter fever duration, fewer lavage procedures, reduced steroid use, and shorter hospital stays compared to the azithromycin group (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.05). Multivariate analysis identified four independent risk factors for RMPP: duration of macrolide use before admission, days of fever before hospitalization, procalcitonin (PCT), and C-reactive protein (CRP). A nomogram based on these factors showed excellent discrimination, with an AUC of 0.982 (95% CI: 0.961\u20131.000). The calibration curve approached the 45-degree line, and decision curve analysis (DCA) indicated that the nomogram provided positive net benefit across a reasonable range of threshold probabilities, supporting its potential clinical utility.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In children with MUMPP, doxycycline treatment is associated with superior clinical outcomes compared to azithromycin. A nomogram incorporating readily available clinical factors can effectively identify patients at risk of developing RMPP, supporting early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1714717","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T14:33:55Z","timestamp":1775658835000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Doxycycline treatment for drug-resistant Mycoplasma pneumoniae pneumonia and evaluation of key predictive factors for refractory disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruijuan","family":"Ren","sequence":"first","affiliation":[{"name":"Children\u2019s Intensive Care Unit of the First Affiliated Hospital of Xinxiang Medical College, Xinxiang","place":["Henan, 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