Efficacy and safety of reduning injection combined with azithromycin in the treatment of mycoplasma pneumonia among children: A systematic review and meta-analysis

Reduning (RDN) injection is a well-known traditional Chinese medicine (TCM) preparation that can be used as an alternative to antibiotics with synergistic and toxicity-reducing effects. In China, RDN is widely used in the combined treatment of infectious diseases.To evaluate the clinical efficacy of RDN combined with azithromycin (AZM) for the treatment of mycoplasma pneumonia (MP) among children and to determine its safety, providing an evidence-based reference for clinical treatment.Eight databases were searched, including 4 English databases, namely, PubMed, EMBASE, the Cochrane Library, and Web of Science, and 4 Chinese databases, namely, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (CQVIP), and Sino-Med. Randomized controlled trials (RCTs) were included in which RDN was combined with AZM for the treatment of MP pediatric patients. A comprehensive search was performed from the inception of each database until April 25, 2022.A total of 20 studies covering 1628 children were included. Meta-analysis showed that the clinical effectiveness rate (RR = 1.20, 95% CI [1.15, 1.26], I2 = 0%), time elapsed until disappearance of cough (MD = -2.04, 95% CI [-2.67, -1.41], I2 = 91%), time elapsed until disappearance of lung rales (MD = -2.55, 95% CI [-3.12, -1.98], I2 = 95%), time elapsed until reduction of fever (MD = -1.93, 95% CI [-2.37, -1.49], I2 = 92%), TNF-α level after treatment (SMD = -1.17, 95% CI [-1.96, -0.39], I2 = 97%), and IL-6 levels after treatment (SMD = -2.65, 95% CI [-3.51, -1.78], I2 = 97%) of the combined treatment of MPP were superior to those of other methods, and incidence of adverse reactions (RR = 0.75, 95% CI [0.56, 1.00], I2 = 0%) showed statistically significant differences.RDN combined with AZM for the treatment of MP among children results in increased clinical efficacy with high safety.