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REVIEW ARTICLE

Clinical effectiveness of traditional Chinese medicine in modulating intestinal microbiota for pediatric Mycoplasma pneumoniae pneumonia: A systematic review and meta-analysis

Keke Li1 ,  Qinghe Zeng1 ,  Jianyi Liu2 ,  Yueyu Ma1 ,  Weiwei Liu2*
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1 Department of Chinese Paediatrics, Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
2 Department of Chinese Paediatrics, The Second Affiliated Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
EJMO, 8602 https://doi.org/10.36922/ejmo.8602
Submitted: 20 January 2025 | Revised: 24 February 2025 | Accepted: 4 March 2025 | Published: 24 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

This research aimed to perform a preliminary meta-analysis to comprehensively examine the effectiveness and safety of herbal medicines in modulating the intestinal microbiota of pediatric patients suffering from Mycoplasma pneumoniae pneumonia (MPP). A systematic search of seven databases was conducted in March 2024. The included randomized controlled trials were evaluated using the Risk of Bias (ROB) 2.0 tool, as recommended in the Cochrane Handbook. The analysis included a total of 11 studies, with a combined sample of 880 children. Traditional Chinese medicine (TCM) significantly enhanced the clinical outcomes of pediatric cases of MPP compared to Western medicine or symptomatic treatment. The meta-analysis results indicated that TCM significantly improved total clinical effectiveness (risk ratio = 1.19, 95% confidence interval [CI]: 1.13, 1.26), increased Bifidobacterium bifidum count (mean difference [MD] = 1.404, 95% CI: 1.180, 1.628), reduced serum interleukin-6 levels (MD = −4.665, 95% CI: −8.191, −1.139), and shortened the time required for rales to resolve (MD = −1.790, 95% CI: −1.951, −1.629) compared to the Western medicine group, with all differences being statistically significant at p < 0.05. Regarding safety, TCM modulation of the intestinal microbiota in treating pediatric mycoplasma pneumonia did not result in a higher incidence of adverse reactions, with the difference being statistically non-significant (p > 0.05). The ROB 2.0 assessment indicated potential bias, and the literature quality was moderate, necessitating future validation by higher-quality studies. The clinical effectiveness of intestinal microbiota-targeted TCM modulation in treating pediatric mycoplasma pneumonia was superior to Western medicine-only treatment, offering significant advantages in reducing inflammatory cell infiltration, shortening the time for rales to resolve, and demonstrating a better safety profile. However, future high-quality, large-scale clinical trials are needed to verify these findings.

Keywords
Intestinal microbiota
Mycoplasma pneumoniae
Traditional Chinese medicine
Systematic review
Meta-analysis
Clinical effectiveness of treatment
Funding
This research was supported by the Tianjin Municipal Education Commission Scientific Research Program Project (Natural Science) Key Project (No. 2021ZD024).
Conflict of interest
The authors declare that they have no relevant financial interests or personal relationships that could influence the objectivity of the research presented in this paper.
References
  1. Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother. 2010;16(3):162-169. doi: 10.1007/s10156-010-0044-x

 

  1. Kumar S, Kumar S. Mycoplasma pneumoniae: Among the smallest bacterial pathogens with great clinical significance in children. Indian J Med Microbiol. 2023;46:100480. doi: 10.1016/j.ijmmb.2023.100480

 

  1. Zhu Y, Luo Y, Li L, et al. Immune response plays a role in Mycoplasma pneumoniae pneumonia. Front Immunol. 2023;14:1189647. doi: 10.3389/fimmu.2023.1189647

 

  1. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004;17(4):697-728, table of contents. doi: 10.1128/CMR.17.4.697-728.2004

 

  1. Gao LW, Yin J, Hu YH, et al. The epidemiology of paediatric Mycoplasma pneumoniae pneumonia in North China: 2006 to 2016. Epidemiol Infect. 2019;147:e192. doi: 10.1017/S0950268819000839

 

  1. Feng, Xue-Li, Li, Q.J., Sun, L., et al. A case-control study of the clinical characteristics of macrolide-resistant and sensitive Mycoplasma pneumoniae. Chin J Evid Based Paediatr. 2016;11(5):357-360.

 

  1. Lee H, Yun KW, Lee HJ, Choi EH. Antimicrobial therapy of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. Expert Rev Anti Infect Ther. 2018;16(1):23-34. doi: 10.1080/14787210.2018.1414599

 

  1. Guo L, Wang J. Clinical prevention of gastrointestinal adverse reactions to macrolide antibiotics in children. In: Proceedings of the 2017 International Digital Medical Society Conference on Digital Traditional Chinese Medicine. Lanzhou, China: Lanzhou General Hospital of Lanzhou Military Region, Department of Pediatrics; Hunan University of Chinese Medicine Journal Press; 2017. p. 444-445.

 

  1. Ling Z, Liu X, Guo S, et al. Role of probiotics in Mycoplasma pneumoniae pneumonia in children: A short-term pilot project. Front Microbiol. 2018;9:3261. doi: 10.3389/fmicb.2018.03261

 

  1. Sun JH, Sun F, Yan B, Li JY, Xin DL. Data mining and systematic pharmacology to reveal the mechanisms of traditional Chinese medicine in Mycoplasma pneumoniae pneumonia treatment. Biomed Pharmacother. 2020;125:109900. doi: 10.1016/j.biopha.2020.109900

 

  1. Liu J, Du Y, Cui T, Wang Y, Chen L, Zhao X. Progress of Chinese medicine in regulating probiotics against pneumonia. World Sci Technol Modern Tradit Chin Med. 2022;24(9):3325-3331.

 

  1. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71

 

  1. Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10(10):Ed000142. doi: 10.1002/14651858.ED000142

 

  1. Wang S, Zhao X, Han X, et al. Guidelines for Chinese medicine treatment of paediatric pneumonia with wheezing and coughing. J Chin Paediatr. 2008;3:1-3.

 

  1. Zhao S, Qian S, Chen Z, et al. Guidelines for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023 edition). Electron J Emerg Infect Dis. 2024;9(1):73-79. doi: 10.19871/j.cnki.xfcrbzz.2024.01.015

 

  1. Xu T, Zhang WY, Ge WM, Zhu MJ. Efficacy of paediatric lung-heat cough granules combined with vitamin D in the treatment of Mycoplasma pneumoniae in children. Chin J Tradit Chin Med.1-11.

 

  1. Sterne JAC, Savovic J, Page MJ, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. doi: 10.1136/bmj.l4898

 

  1. Huang W. Exploring the Mechanism of Action of Flavour-added Ma Xing Shi Gan Tang in the Treatment of Community-Acquired Pneumonia in Children Based on the Theory of Lung-Intestinal Axis and Network Pharmacology. Master; 2022. Available from: https://link.cnki.net [Last accessed 2025 Mar 20].

 

  1. Ke S, Zhang D, Zhang H. Effects of Jiawei Qianjin Reed Stem Tang on the expression of regulatory T cells and its related protein Foxp3 in children with Mycoplasma pneumonia. J Chin Med. 2018;33(8):1388-1391. doi: 10.16368/j.issn.1674-8999.2018.08.329

 

  1. Li X, Bai X. Effect of Jiawei Dabanemerosa Dazao Diarrhoea Lung Tang combined with conventional Western medicine on the intestinal flora of children with acute exacerbation of paediatric Mycoplasma pneumonia combined with bronchial asthma. Hebei Tradit Chin Med. 2021;43(5):806-810.

 

  1. Liu J. Effect of Chinese medicine application at lung acupoints combined with bacterial lysis products on the efficacy and immune function of paediatric mycoplasma pneumonia. Shanxi Tradit Chin Med. 2022;38(12):42-44. doi: 10.20002/j.issn.1000-7156.2022.12.017

 

  1. Sha G. Study on the application of Nourishing Yin and Clearing Lung Soup combined with Azithromycin in the treatment of children with Mycoplasma pneumoniae. Electron J Modern Med Health Res. 2022;6(1):105-108.

 

  1. Yang Y. Application of Jiawei Wuhu Tang in the treatment of paediatric mycoplasma pneumonia. Guangming Tradit Chin Med. 2023;38(5):885-888.

 

  1. Zhong S. Efficacy of traditional Chinese medicine acupoint application combined with budesonide in the treatment of paediatric mycoplasma pneumonia and its effect on inflammation level and immune function. Intern Med. 2023;18(6):561-566. doi: 10.16121/j.cnki.cn45-1347/r.2023.06.11

 

  1. Bao C. The Effect of Xuanbai Chengqi Tang on the Intestinal Microecology of MPP Based on the Theory of “Lung and Large Intestine are Mutually Exclusive”. Master; 2021. Availale from: https://link.cnki.net [Last accessed 2025 Mar 20].

 

  1. Bao C, Jiang Y. Effect of Xuanbai Chengqi Tang with added flavour on intestinal flora and sIgA levels in children with Mycoplasma pneumoniae pneumoniae with phlegm-heat closure of the lungs. Shanghai J Tradit Chin Med. 2022;56(7):53-58. doi: 10.16305/j.1007-1334.2022.2202020

 

  1. Di W, Lu Y, Zhan H. Efficacy of Xuanlong Tongluo Formula in treating paediatric Mycoplasma pneumoniae pneumonia and its effects on inflammatory factors, sIgA, hBD2 and CAL. Eval Anal Drug Chin Hosp. 2023;23(2):178-181. doi: 10.14009/j.issn.1672-2124.2023.02.010

 

  1. Hua J. Clinical efficacy of Ma Xing Shi Gan Tang on paediatric pneumonia patients with wind-heat and lung stagnation. Chin Patent Med. 2024;46(1):340-342.

 

  1. Wang L, Hao Z, Duan L, Zhang J, Wang X, Zhang Z. Clinical application of Ma Xing Shi Gan Tang. Henan Tradit Chin Med. 2024;44(7):1000-1005. doi: 10.16367/j.issn.1003-5028.2024.07.0184

 

  1. Xu Y, Ding C, Li D, et al. PD-1/PD-L1-based study on the mechanism of Ma Xing Shi Gan Tang in balancing lung inflammation and immune microenvironment disorder. Shizhen Guomian Guomao. 2024;35(11):2518-2522.

 

  1. Zhou FF, Shang LL, Wang JJ. Efficacy analysis of the treatment of paediatric Mycoplasma pneumoniae pneumonia by adding flavour to Ma Xing Shi Gan Tang and combining with acupressure method. Chin Family Med. 2025;23(02):253- 256+281. doi: 10.16766/j.cnki.issn.1674-4152.003879

 

  1. Canavan TN, Mathes EF, Frieden I, Shinkai K. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: A systematic review. J Am Acad Dermatol. 2015;72(2):239-245. doi: 10.1016/j.jaad.2014.06.026

 

  1. Song Z, Jia G, Luo G, Han C, Zhang B, Wang X. Global research trends of Mycoplasma pneumoniae pneumonia in children: A bibliometric analysis. Front Pediatr. 2023;11:1306234. doi: 10.3389/fped.2023.1306234

 

  1. Esposito S, Cavagna R, Bosis S, Droghetti R, Faelli N, Principi N. Emerging role of Mycoplasma pneumoniae in children with acute pharyngitis. Eur J Clin Microbiol Infect Dis. 2002;21(8):607-610. doi: 10.1007/s10096-002-0780-7

 

  1. Guo B, Qiao J, Pang X, Li H, Hou Y, Tian J. Correlation analysis of 23S rRNA gene locus mutations with antibiotic resistance in Mycoplasma pneumoniae pneumonia in children. Chinese J Hyg Inspect. 2022;32(15):1836-1839.

 

  1. Gu Y, Yang F, Ye J, Hua L, Li J, Ding GD. Macrolide resistance and clinical management of Mycoplasma pneumoniae in hospitalised children. J Clin Paediatr. 2024;42(3):182- 186+192.

 

  1. Xue H. An investigation of the progress of drug treatment of paediatric Mycoplasma pneumoniae pneumonia. China Prescrip Drugs. 2020;18(1):12-13.

 

  1. Chen G. Feasibility analysis of macrolide antibiotics combined with traditional Chinese medicine soup in the treatment of paediatric mycoplasma pneumonia. China Rural Health. 2019;11(24):41+43.

 

  1. Jiang Z, Li S, Zhu C, Zhou R, Leung PHM. Mycoplasma pneumoniae infections: Pathogenesis and vaccine development. Pathogens. 2021;10(2):119. doi: 10.3390/pathogens10020119

 

  1. Wang X, Ren Y, Li W. Exploring the relationship between pneumonia cough and intestinal flora based on “lung and intestinal treatment together”. J Chin Med. 2023;38(12): 2493-2498. doi: 10.16368/j.issn.1674-8999.2023.12.399

 

  1. Yuan Yu. Exploring the relationship between intestinal flora dysbiosis and cellular immunity in children with bronchopneumonia. China Med Innov. 2021;18(14):67-70.

 

  1. Shi S, Zhang X, Zhou Y, Tang H, Zhao D, Liu F. Immunosuppression reduces lung injury caused by Mycoplasma pneumoniae infection. Sci Rep. 2019;9(1):7147. doi: 10.1038/s41598-019-43451-9

 

  1. Hu Y, Gao G, Li X, Xiang H, Feng Q. Relationship between intestinal flora and serum interferon-γ and interleukin-4 levels in children with Mycoplasma pneumoniae. West Med. 2021;33(11):1687-1690.

 

  1. Liu S, Xing Y, Yang Y, Pei X, Guan L. Traditional Chinese medicine nursing programme for children with Mycoplasma pneumoniae Pneumoniae in Beijing (Version 2023). Beijing Tradit Chin Med. 2023;42(12):1302-1306. doi: 10.16025/j.1674-1307.2023.12.005

 

  1. Yang M, Meng F, Gao M, Cheng G, Wang X. Cytokine signatures associate with disease severity in children with Mycoplasma pneumoniae pneumonia. Sci Rep. 2019;9(1):17853. doi: 10.1038/s41598-019-54313-9

 

  1. Geginat J, Paroni M, Maglie S, et al. Plasticity of human CD4 T cell subsets. Front Immunol. 2014;5:630. doi: 10.3389/fimmu.2014.00630

 

  1. Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 2014;6(10):a016295. doi: 10.1101/cshperspect.a016295

 

  1. Rose-John S. Interleukin-6 family cytokines. Cold Spring Harb Perspect Biol. 2018;10(2):a028415. doi: 10.1101/cshperspect.a028415

 

  1. Wu X, Li H, Sun D, Han Y, Li X. Network pharmacological mechanism of Mycoplasma pneumoniae and bronchial asthma by “different diseases treated together” with Ma Xing Shi Gan Tang. Tianjin Tradit Chin Med. 2023;40(7):916-924.

 

  1. Wang Y, Peng H, Wang A, Zhang W, Bai C, Li P. Molecular mechanism of ephedra apricot shikimantang in the treatment of pneumonia revealed based on transcriptional profiling and structural data of traditional Chinese medicines. Chin J Exp Formulas.1-11. doi: 10.13422/j.cnki.syfjx.20250219

 

  1. Wang QY, Tao LM. Effect of Yin Qiao San combined with the addition and subtraction formula of Ma Xing Shi Gan Tang on Th1/Th2 and Th17/Treg cytokines in paediatric Mycoplasma pneumoniae with wind-heat and lung closure syndrome. Chin Pharm. 2024;27(3):440-446.

 

  1. Li Y, Chen D. Clinical significance and prognostic assessment value of CXC chemokine ligand 8, nuclear transcription factor κB, and soluble B7-H3 in children with Mycoplasma pneumoniae pneumonia. J Women’s Child Health. 2024;3(20):194-199.

 

  1. Ma C, Hao X, Gao L, et al. Extracellular vesicles released from macrophages infected with Mycoplasma pneumoniae stimulate proinflammatory response via the TLR2-NF-κB/ JNK signaling pathway. Int J Mol Sci. 2023;24(10):8588. doi: 10.3390/ijms24108588

 

  1. Thompson S, Pang CY, Sepuru KM, et al. Nitration of chemokine CXCL8 acts as a natural mechanism to limit acute inflammation. Cell Mol Life Sci. 2023;80(1):35. doi: 10.1007/s00018-022-04663-x

 

  1. Janakiram M, Shah UA, Liu W, Zhao A, Schoenberg MP, Zang X. The third group of the B7-CD28 immune checkpoint family: HHLA2, TMIGD2, B7x, and B7-H3. Immunol Rev. 2017;276(1):26-39. doi: 10.1111/imr.12521

 

  1. Liu YL, Shang YF, Gui MZ, Li QH. Diagnostic value of combined serum CCL5 and sB7-H3 levels for refractory mycoplasma pneumonia in children. J Clin Pulmonol. 2024;29(4):492-496.

 

  1. Wolf J, Rose-John S, Garbers C. Interleukin-6 and its receptors: A highly regulated and dynamic system. Cytokine. 2014;70(1):11-20. doi: 10.1016/j.cyto.2014.05.024

 

  1. Zhu Y. Exploring Prescription Drug Use Patterns and Mechanisms of Action of Mycoplasma pneumoniae Pneumonia in Children Based on Data Mining and Network Pharmacology. Master; 2023. Available from: https://link. cnki.net [Last accessed 2025 Mar 20].

 

  1. Al-Khayri JM, Sahana GR, Nagella P, Joseph BV, Alessa FM, Al-Mssallem MQ. Flavonoids as potential anti-inflammatory molecules: A review. Molecules. 2022;27(9):2901. doi: 10.3390/molecules27092901

 

  1. Yang Y. Exploring the mechanism of action of Er Chen Tang in the treatment of chronic bronchitis based on network pharmacology and molecular docking. Med Inform. 2024;37(13):7-12.

 

  1. Tang X, Liu J, Dong W., et al. Interventional effects of quercetin on inflammatory secretion of cardiac fibroblasts in rat suckling mice. Chin J Tradit Chin Med. 2014;39(12): 2314-2317.

 

  1. Wang Y, Zhang M, Meng J, Guo B, Wang L. Effect of naringenin on lung tissue repair and high mobility group protein B1/nuclear factor-κB signalling pathway in Mycoplasma pneumoniae-infected mice. Anhui Med. 2024;28(7):1318-1322+1486.

 

  1. Xia J, Ma J, Zhang R, Yu Y. Mechanism of protection against Mycoplasma pneumoniae pneumoniae in rats by inhibition of high mobility group protein/Toll-like receptor 4 pathway by Sangbaekpi extract. J Paediatr Pharmacol. 2024;30(1):1-5. doi: 10.13407/j.cnki.jpp.1672-108X.2024.01.001

 

  1. Bao S, Yan S, Chen T, Chen J, Li J, Hui Y. Research progress of lung and intestine combination therapy in the treatment of pulmonary diseases. Chin J Exp Formulas. 2022;28(8):116-122. doi: 10.13422/j.cnki.syfjx.20220708

 

  1. Budden KF, Gellatly SL, Wood DL, et al. Emerging pathogenic links between microbiota and the gut-lung axis. Nat Rev Microbiol. 2017;15(1):55-63. doi: 10.1038/nrmicro.2016.142

 

  1. Yang Q, Hao M, Jiang H. Changes of inflammatory factors and bacterial flora in lung and intestinal tissues by Chinese herbal medicine intervention in pulmonary diseases based on “lung and large intestine compare with each other”. J Pract Chin Med. 2024;38(3):136-138. doi: 10.13729/j.issn.1671-7813.Z20230203

 

  1. Mann ER, Lam YK, Uhlig HH. Short-chain fatty acids: Linking diet, the microbiome and immunity. Nat Rev Immunol. 2024;24(8):577-595. doi: 10.1038/s41577-024-01014-8

 

  1. Yang D, Lin J, Wang T, Liu H. Progress in the study of disease intervention by Chinese medicines regulating metabolites of intestinal flora. J Bioeng. 2025:1-30. doi: 10.13345/j.cjb.240996

 

  1. Zhao W, Duan C, Liu Y, et al. Modulating effects of Astragalus polysaccharide on immune disorders via gut microbiota and the TLR4/NF-κB pathway in rats with syndrome of dampness stagnancy due to spleen deficiency. J Zhejiang Univ Sci B. 2023;24(7):650-662. doi: 10.1631/jzus.B2200491

 

  1. Dong K, Gao Y, Qin N, Su L. Effects of Ginseng Ling Bai Zhu San on antibiotic-induced intestinal flora dysbiosis in mice. Chin J Exp Formulas. 2015;21(1):154-157. doi: 10.13422/j.cnki.syfjx.2015010154

 

  1. Mitchell TJ, Dalziel CE. The biology of pneumolysin. Subcell Biochem. 2014;80:145-160. doi: 10.1007/978-94-017-8881-6_8

 

  1. Kadioglu A, Weiser JN, Paton JC, Andrew PW. The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nat Rev Microbiol. 2008;6(4):288-301. doi: 10.1038/nrmicro1871

 

  1. Witzenrath M, Pache F, Lorenz D, et al. The NLRP3 inflammasome is differentially activated by pneumolysin variants and contributes to host defense in pneumococcal pneumonia. J Immunol. 2011;187(1):434-440. doi: 10.4049/jimmunol.1003143

 

  1. Guo T, Guo Y, Liu Q, et al. The TCM prescription Ma-Xing-Shi-Gan-Tang inhibits Streptococcus pneumoniae pathogenesis by targeting pneumolysin. J Ethnopharmacol. 2021;275:114133. doi: 10.1016/j.jep.2021.114133

 

  1. Li Y, Yang Q, Hao M, Zhang K. Exploring the mechanism of inhibition of influenza virus pneumonitis by Ma Xing Shi Gan Tang based on the lung-intestinal axis. Shizhen Guomian Guomao. 2024;35(9):2135-2139.

 

  1. Ye C, Gao ZH, Bie ZY, Chen KQ, Lu FG, Wei K. MXSGD alleviates CsA-induced hypoimmunity lung injury by regulating microflora metabolism. Front Immunol. 2023;14:1298416. doi: 10.3389/fimmu.2023.1298416

 

  1. Lin H. The real mechanisms of emodin treating lung cancer based on system pharmacology. Eur J Med Oncol. 2023;7: 10-23. doi:10.14744/ejmo.2023.35261

 

  1. Xie S. Effectiveness of paediatric eliminating accumulation and relieving cough oral solution combined with doxycycline in the treatment of children with Mycoplasma pneumoniae pneumonia. Zhongguo NK Med. 2025;37(03):101-103.

 

  1. Long J. Effect of Xuanbai Chengqi Tang combined with azithromycin on the short-term prognosis of paediatric severe pneumonia. Chin Prescrip Drugs. 2021;19(07):107-109.

 

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