High-Dose versus Low-Dose Methylprednisolone in the Treatment of Pediatric Refractory Mycoplasma Pneumoniae Pneumonia: A Real-World Study

Background Refractory Mycoplasma pneumoniae pneumonia (RMPP) is a critical pediatric condition with persistent symptoms despite antibiotic treatment. The optimal corticosteroid dosing for RMPP remains controversial. This study evaluates the effectiveness and safety of high and low doses of methylprednisolone for treating pediatric RMPP. Methods This retrospective study included 66 children diagnosed with RMPP between October 2023 and October 2024. Patients were categorized into two groups: high-dose methylprednisolone (≥ 3 mg/kg/day) and low-dose (< 3 mg/kg/day). Clinical outcomes, hospitalization costs, biomarkers, radiological features, and the safety of methylprednisolone therapy were assessed. Results The high-dose group had a significantly shorter time to defervescence (1.47 ± 0.83 days vs. 2.14 ± 1.66 days, P = 0.04), but no significant differences in hospital stay length or costs. Laboratory findings showed higher D-dimer levels in the high-dose group (1.64 mg/L vs. 1.12 mg/L, P = 0.014). ROC analysis identified an LDH cutoff of 333.5 U/L as a potential predictor for high-dose methylprednisolone use (AUC = 0.681, P = 0.036). Both groups demonstrated good tolerability to methylprednisolone, with no severe adverse effects, except for one case of increased intraocular pressure. Conclusion High-dose methylprednisolone reduces defervescence time, but does not decrease hospital stay length or costs in children with RMPP. Elevated LDH and D-dimer levels may serve as biomarkers for disease severity and guide corticosteroid dosing.