Refractory Mycoplasma pneumoniae pneumonia generally refers to Mycoplasma pneumoniae pneumonia treated with macrolide antibiotics (erythromycin, roxithromycin, azithromycin) with poor results (no improvement over a week with macrolide antibiotics alone), children with severe disease (in addition to severe pulmonary lesions there may be multisystem extra-pulmonary damage) or those who do not recover (disease duration often greater than 4 weeks). Etiology: 1. Immune mechanisms and involvement of excessive inflammatory response Abnormal immune response and process inflammatory response are closely related to the development of refractory pneumonia. Children with Mycoplasma pneumoniae infection may have immunosuppression and autoimmune reactions, often with cellular immune dysfunction and low humoral immune function, which affect the clearance of mycoplasma and the recovery of the disease. 2. drug resistance problems; 3. mycoplasmaemia; 4. mixed infections Mixed infections can aggravate the disease, making treatment more difficult and prolonging the course of the disease. Because of the strong destructive effect of Mycoplasma pneumoniae on the ciliated epithelium, it may create conditions for secondary bacterial and other infections. Mixed bacterial infections are the most common. 5, intrapulmonary complications Due to the destruction of the ciliary mucosa epithelium by Mycoplasma pneumoniae leads to significant inflammation of the large and small airways and causes airway obstruction, on the other hand, due to the abnormal immune response and excessive inflammatory response in the lung, it can cause obstructive pneumonia, pleural effusion, occlusive bronchitis, occlusive capillary bronchitis, pulmonary atelectasis, necrotizing pneumonia and even lung abscess formation, seriously affecting the ventilation and ventilation function, and even respiratory failure. Even respiratory failure occurs. The antibiotic treatment for Mycoplasma pneumoniae pneumonia in children is still based on macrolides, including erythromycin, azithromycin, clarithromycin, and roxithromycin. The general treatment course is 3-4 weeks, and it is easy to relapse if the drug is stopped too early. The combination of other antibacterial drugs should be considered for those with persistently elevated inflammatory indicators such as total blood leukocyte count and C-reactive protein after macrolide antibiotic treatment. 2. Immunosuppression and immunomodulation Considering the role of abnormal immune response and excessive inflammatory response in severe Mycoplasma pneumoniae pneumonia, and that glucocorticoids are currently the most effective anti-inflammatory drugs, there are theoretical indications for hormone application in Mycoplasma pneumoniae pneumoniae pneumoniae with rapid development of acute phase and severe disease or lung changes with complications. Immune-enhancing agents can be added appropriately for those who are young, have a long course of disease, and have a slow recovery due to immunocompromise.