Mycoplasmal pneumoniae pneumonia (MPP) is a common respiratory disease in children. The incidence of severe MPP (SMPP) has increased and the situation is critical due to a variety of factors such as declining herd immunity, macrolide antibiotic resistance, delayed diagnosis and treatment, and mixed infection. Most children with SMPP have severe clinical symptoms and a long course of disease. SMPP is prone to serious complications such as lung consolidation, atelectasis, plastic bronchitis, necrotizing pneumonia, and extrapulmonary manifestations, leaving behind chronic lung diseases such as bronchiectasis and bronchiolitis obliterans, which affect the quality of children’s life. Children who are likely to develop SMPP should be given high attention. Early identification of SMPP with macrolide-resistant can be achieved by clinical manifestations, relevant laboratory tests, lung imaging, and bronchoscopic changes, and individualized treatment plan can be adjusted in time. Early diagnosis and effective treatment can alleviate the pain of children, shorten the course of disease, and reduce the incidence of severe diseases. This article reviews the early identification and treatment of severe macrolide-resistant MPP in children.

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