Objective To investigate the factors influencing poor clinical outcomes in children with macrolide-resistant Mycoplasma pneumoniae (MRMP) pneumonia treated with doxycycline.

Methods A retrospective analysis was conducted on the clinical data of pediatric patients with MRMP pneumonia admitted to the Department of Pediatrics at Zhoushan Putuo District People's Hospital between March 2023 and December 2025. Patients were divided into an effective group and an ineffective group based on therapeutic efficacy after 7 days of treatment. Baseline characteristics were compared between the two groups, and multivariate Logistic regression analysis was used to identify independent factors influencing treatment efficacy.

Results A total of 112 pediatric patients with MRMP pneumonia were included, comprising 89 in the effective group and 23 in the ineffective group. The overall effective rate was 79.46%, and the incidence of adverse reactions was 7.10%. Multivariate analysis revealed that age <6 years [OR=3.87, 95% CI (1.56, 9.59)], C-reactive protein ≥50 mg·L^-1 [OR=4.22, 95% CI (1.74, 10.21)], and concurrent pleural effusion [OR=3.55, 95% CI (1.33, 9.48)] were factors associated with treatment ineffectiveness (all P<0.05).

Conclusion Age <6 years, C-reactive protein ≥50 mg·L^-1, and concurrent pleural effusion are factors associated with poor clinical outcomes in children with MRMP treated with doxycycline; therefore, strengthened individualized interventions are required.

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