JMDSJournal of Medicines Development Sciences2382-63632382-6371WHIOCE PUBLISHING PTE. LTD.10.18063/JMDS.v11i2.2005ArticleComparison of the Efficacy of Two Initial Treatment Regimens for Macrolide-Unresponsive Mycoplasma Pneumoniae Pneumonia in Childrenhttps://artdesignp.com/journal/JMDS/11/2/10.18063/JMDS.v11i2.2005LiuShan,WanLinfang20261122026-06-23Objective: To compare the clinical efficacy of two first-line regimens—azithromycin combined with methylprednisolone versus doxycycline monotherapy—in the treatment of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children. Methods: A retrospective study design was adopted. Children with MUMPP hospitalized in our institution from January 2023 to December 2023 were enrolled and divided according to their initial treatment regimen into Group A (azithromycin + methylprednisolone) and Group B (doxycycline monotherapy). Only cases that achieved clinical cure following the initial regimen were included in the between-group comparative analysis. The adjusted length of hospital stay required for clinical cure, time to effective defervescence, and pulmonary imaging resolution were compared between the two groups. Between-group comparisons were performed using the chi-squared test and the Mann–Whitney U test. Results: A total of 79 children with MUMPP who responded to treatment and met the discharge criteria for clinical cure were included, comprising 39 in Group A and 40 in Group B. No statistically significant difference in pulmonary imaging findings at discharge was observed between the two groups (P>0.05). The adjusted length of hospital stay was significantly shorter in Group B than in Group A (5 (IQR, 4–6) days vs. 7 (IQR, 6–9) days, p = 0.005). The time to effective defervescence did not differ significantly between the two groups. No serious adverse events occurred in either group. Conclusion: In children with MUMPP who respond to initial treatment, azithromycin combined with methylprednisolone and doxycycline monotherapy demonstrate comparable efficacy in terms of time to defervescence and final pulmonary imaging resolution; however, doxycycline significantly shortens the length of hospital stay required to achieve clinical cure.Children,Macrolide-unresponsive Mycoplasma pneumoniae pneumonia,Doxycycline,Azithromycin,Methylprednisolone

[1] Diaz MH, Hersh AL, Olson J, et al., 2025, Mycoplasma pneumoniae Infections in Hospitalized Children - United States, 2018-2024. MMWR Morb Mortal Wkly Rep, 74(23): 394-400. DOI:10.15585/mmwr.mm7423a1. [2] Wang X, Li M, Luo M, et al., 2022, Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: a multicentre, population-based epidemiological study between 2015 and 2020. Emerg Microbes Infect, 11(1): 1508-1517. DOI:10.1080/22221751.2022.2078228. [3] Waites KB, Xiao L, Liu Y, et al., 2017, Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev, 30(3): 747-809. DOI:10.1128/CMR.00114-16. [4] Li ZJ, Zhang HY, Ren LL, et al., 2021, Etiological and epidemiological features of acute respiratory infections in China. Nat Commun, 12(1): 5026. DOI:10.1038/s41467-021-25120-6. [5] Fu C, Mo L, Feng Y, et al., 2025, Detection of Mycoplasma pneumoniae in hospitalized pediatric patients presenting with acute lower respiratory tract infections utilizing targeted next-generation sequencing. Infection, 53(4):1437-1447. DOI:10.1007/s15010-024-02467-8. [6] Wang J, Wu M, Liu M, et al., 2025, Panoramic quantitative and visualization-based bibliometric analysis of Mycoplasma pneumoniae. Infection. 53: 1699–1713. DOI:10.1007/s15010-025-02482-3. [7] Wang YS, Zhou YL, Bai GN, et al., 2024, Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. World J Pediatr, 20(9): 901-914. DOI:10.1007/s12519-024-00831-0. [8] National Health Commission of the People's Republic of China, 2023, Guidelines for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023 edition). Int J Epidemiol Infect Dis, 50(2): 79-85. [9] Prebble K, Marefat L, 2025, Impact of Comprehensive Education on Antibiotic Duration of Therapy for Community-Acquired Pneumonia in a Community Hospital. Hosp Pharm, 61(2): 00185787251390774. DOI:10.1177/00185787251390774. [10] Nguyen DD, Ho NT, Dover LG, et al., 2024, Novel Variant and Known Mutation in 23S rRNA Gene of Mycoplasma pneumoniae, Northern Vietnam, 2023. Emerg Infect Dis, 30(5): 1034-1036. DOI:10.3201/eid3005.231632.