Efficacy of azithromycin sequential therapy combined with montelukast in the treatment of pediatric mycoplasma pneumonia: A meta-analysis
Abstract
Background: Mycoplasma pneumoniae pneumonia (MPP) stands as a predominant cause of community-acquired respiratory infections in children. With the increasing prevalence of macrolide-resistant Mycoplasma pneumoniae strains, the therapeutic efficacy of azithromycin monotherapy has become a growing concern in clinical practice. Montelukast sodium, a selective leukotriene receptor antagonist, has emerged as a promising adjunctive agent, as it can effectively alleviate airway inflammation and reduce airway hyperresponsiveness. This meta-analysis was designed to systematically evaluate the efficacy and safety of azithromycin sequential therapy combined with montelukast in the management of pediatric MPP. Methods: A comprehensive literature search was conducted across PubMed, Embase, Web of Science Core Collection, Wanfang Data, Variant Impact Predictor database, and Chinese National Knowledge Infrastructure from the establishment of each database up to November 2025. Eligible studies were randomized controlled trials (RCTs) that compared azithromycin sequential monotherapy with azithromycin sequential therapy plus montelukast in pediatric patients diagnosed with MPP. Primary outcome measures included overall clinical efficacy, resolution time of key clinical symptoms (cough, wheezing, pulmonary rales, and fever), and the incidence of adverse events. Results: Thirty-six RCTs involving 3450 pediatric patients (1726 in the combination group and 1724 in the azithromycin group) met the…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,450 participants or records.
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