Comparison of Different Corticosteroid Regimens for Refractory Mycoplasma pneumoniae Pneumonia in Children: A Retrospective Cohort Study.

Authors

Yahong Wang, Man Zhang, Xia Qin

Published in

Infection and drug resistance. Volume 19. Pages 630304. Epub Sep 29, 2026.

Abstract

Refractory Mycoplasma pneumoniae pneumonia (RMPP) poses a significant therapeutic challenge in pediatric practice, and the optimal corticosteroid regimen remains controversial. This study aimed to compare the clinical efficacy and safety of three corticosteroid regimens in children with RMPP.
In this retrospective cohort study, 216 children with RMPP hospitalized between January 2023 and June 2025 were categorized by corticosteroid regimen: Group A (low-dose methylprednisolone, 1-2 mg/kg/day intravenously for 3-5 days, n=73), Group B (high-dose methylprednisolone pulse therapy, 10-30 mg/kg/day for 3 days, n=70), and Group C (step-down regimen: pulse therapy for 3 days followed by an oral prednisolone taper, n=73). The primary outcome was time to fever resolution after corticosteroid initiation. Multivariable logistic and Cox regression, inverse probability of treatment weighting (IPTW), and E-value analyses were performed.
Baseline characteristics were largely comparable, although white blood cell counts differed (P=0.013). Defervescence was faster in Groups B (2.40 ± 1.00 days) and C (2.00 ± 0.78 days) than in Group A (4.25 ± 1.71 days; both P<0.001); the Group C-versus-Group B difference (adjusted P=0.047) occurred largely before the oral taper began. Group C had the shortest hospital stay (8.26 ± 1.74 days) and the highest treatment effectiveness (89.04% vs 82.86% vs 64.38%; P=0.001), but the adjusted Group C-versus-Group B comparison was not significant (OR 2.17; 95% CI 0.77-6.12). Both high-dose regimens were independently associated with treatment effectiveness versus Group A (Group C: OR 5.26, 95% CI 2.08-13.32; E-value 2.16) and with faster defervescence; IPTW analyses yielded consistent results. Thirty-day readmission did not differ significantly (exact P=0.130).
High-dose corticosteroid regimens were associated with faster defervescence and higher treatment effectiveness than low-dose therapy in children with RMPP. Whether an oral taper after pulse therapy provides additional benefit remains uncertain and warrants prospective validation.

PMID:
42829736
Bibliographic data and abstract were imported from PubMed on 04 Oct 2026.

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