Abstract: Objective　To analyze the clinical features and treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP). Method　Retrospective analysis was performed on the clinical data of 193 children with MPP. According to the reaction to the initial administration of erythromycin 20-30 mg/(kg•d) for 7 days, the subjects were divided into general group and refractory group. The clinical manifestations, laboratory examination and imaging characteristics of two groups were compared. The critical values of each independent factors related with RMPP had been detected. Results　In 193 subjects, 35 (18.1%) subjects had no response to erythromycin treatment were recruited into the refractory group, while another 158 cases with responseinto the general group. Between two groups, the duration of fever, percentage of neutrophils (N), C-reactive protein (CRP), serum ferritin (SF), lactic dehydrogenase (LDH), creatine kinase isoenzyme (CK-MB) were statistically significant (P<0.01). In general group, 70 subjects (44.3%) showed the large consolidation in single lobe of lung, 80 subjects (50.6%) showed multiple cloudiness shadow in unilateral or bilateral lung fields, and 8 subjects (5.1%) showed bilateral pulmonary bronchitis. In refractory group, 31 subjects (88.6%) showed the large consolidation in single lobe of lung, 4 cases (11.4%) showed bilateral pulmonary bronchitis. The proporttion of large consolidation in lung was significantly dirrerent between two groups (χ2=22.51,P<0.05) . In refractory group, the scope of consolidation in lung expanded and over the two-thirds of lung after 7 days. Calculated by the area under the ROC curves, the CRP, SF, LDH, and N were the prediction indicators of erythromycin treatment with no response. The cut off value was 51 mg/L, 258 g/L, 353 IU/L, and 0.71 respectively. Conclusion　RMPP is suggested when the MPP children has no response to erythromycin treatment, persistent fever. CRP ≥ 51 mg/L, SF ≥ 258 g/L, LDH ≥ 353 IU/L, N ≥ 71, and chest radiograph shows more than two-thirds of lung dense consolidation. The anti-inflammatory therapy of methylprednisolone should be considered.