Pediatric investigation study identifies the optimal dose of methylprednisolone for treating severe mycoplasma pneumoniae pneumonia

Mycoplasma pneumoniae infection is the main cause of community-acquired pneumonia in children aged five and above. The incidence of severe M. pneumoniae pneumonia (MPP) is rising worldwide, with approximately 42.6% cases categorized as severe MPP. Primary treatment for MPP is using macrolides antibiotics. Given that inflammation plays a key role in severe MPP progression, the antibiotics are often combined with glucocorticoids like methylprednisolone. Although, adding glucocorticoids effectively prevents pulmonary lesions caused by severe MPP, there is no clear evidence-based determination of the optimal effective dose.

To address this knowledge gap, Professors Baoping Xu, Kunling Shen, and Xiaoxia Peng from Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China, collaborated with researchers from Capital Center for Children’s Health, Capital Medical University, Shengjing Hospital of China Medical University, Shanxi Children’s Hospital, and Baoding Children’s Hospital. The research group conducted a multi-center, randomized clinical trial to compare low- and high-dosage of methylprednisolone (an anti-inflammatory drug) in combination with azithromycin as a therapy for severe MPP in children. This paper was made available online in mm, dd, 2025 and was published in Volume X, Issue X of the journal Pediatric Investigation.

Highlighting the global impact of MPP, Prof. Xu cites, “The first global prospective surveillance study of M. pneumoniae from 45 sites in 24 countries, showed a significant surge in severe cases and extrapulmonary manifestations following three years of COVID-19 pandemic.” It is therefore essential to determine the optimal therapy that improves prognosis, and has minimal side effects.

Here, the study group including pediatric patients with severe MPP was split into two treatment categories. One group received low-dose methylprednisolone combined with azithromycin, while the other group received high-dose methylprednisolone with azithromycin. The primary outcomes measured in this study were the incidence of adverse outcomes at six months after treatment.

The authors report that patients in both the high-dose and low-dose methylprednisolone groups developed pulmonary lesions at six months after treatment. In the long-term, pulmonary lesions can cause impairment in functioning, which might develop during adulthood and increase susceptibility to other chronic pulmonary diseases. They found that the risk of developing pulmonary lesions was not different between the two groups. Of note, the risk of high blood pressure was higher in the high-dose group than in the lower-dose group.

Also, the high-dose group showed minimal reduction in long-term pulmonary lesions and the improvements in clinical outcomes were not well pronounced.

The authors suggest that azithromycin combined with low-dose methylprednisolone is just as effective as the high-dose in preventing pulmonary lesions but has a better safety profile with fewer adverse effects.

The findings from this study are important, especially because most of the previous studies were retrospective and limited to data from a single center. Reports of macrolide-resistant M. pneumoniae strains are of increasing concern. Prof. Xu explains the implications, “Inflammatory response is one of the important mechanisms that cause severe MPP, which presents additional therapeutic challenges. Studies have reported that the therapeutic efficacy of macrolide is greatly reduced, potentially contributing to poorer outcomes.” The authors suggest that corticosteroids will play a crucial role at this juncture and be useful in combination with antibiotics in improving patient prognosis.

This study also improves the understanding about the anti-inflammatory effects of methylprednisolone, while providing evidence regarding its low-dose regimen.  In summary, this outcome evaluation study provides clinical evidence that lower dose regimen of glucocorticoids is sufficient, equally effective, and a much safer option, compared to the high dose regimen. This new evidence supports clinical decision-making and improved management of severe MPP in pediatric patients.

With continued innovation and research, let us hope for this optimized dosage levels to maximize benefit and transform patient care!

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Reference
DOI: 10.1002/ped4.70014

Professor Baoping Xu from National Center for Children’s Health
Professor Baoping Xu is a Professor at the Department of Respiratory Medicine, Beijing Children’s Hospital, Capital Medical University, Beijing, China; the Head of the Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical Association. Her research expertise is in pediatric infectious diseases, pneumonia, and epidemiological studies. She has published more than 100 research publications with more than 2,000 citations to her credit. Her expertise has led to many international collaborations and involvement in clinical trials for pediatric patients.

Professor Kunling Shen from National Center for Children’s Health
Professor Kunling Shen is the Vice President of Beijing Children's Hospital since 1998. Prof. Shen is the former President of Chinese Pediatric Society of Chinese Medical Association, Chairman of the sub-society of Pediatric Pulmonology of Chinese Pediatric Society and President of the Asia Respiratory Society. Her research focuses on bronchial asthma in children, respiratory virus infections in infants, and in immunodeficient children. She has published over a 100 academic manuscripts and serves on the editorial board of The Asia, Pacific Academy of Pediatric Allergy, Respirology & Immunology.