Objective To explore the predictive value of blood interleukin (IL)-17A in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods Clinical data of children with Mycoplasma pneumoniae pneumonia (MPP) admitted from January 2019 to October 2021 were retrospectively analyzed. The enrolled children were divided into the MPP and the RMPP group. The differences of infection-related indexes between the two groups were compared, and the value of these indicators in predicting RMPP was evaluated by ROC curves. Results A total of 63 children with MPP were included in the study, including 42 cases in MPP group and 21 cases in RMPP group. There were 43 males and 20 females with a median age of 4.9(1.8-12.0) years and no significant differences was found in gender and age between the two groups (P>0.05). The proportion of lobar consolidation, pleural effusion, moxifloxacin, glucocorticoid and bronchoscopy in RMPP group were higher than those in MPP group (P<0.05). Also, IL-17A, IL-18, LDH and ferritin levels in RMPP group were higher (P<0.05). The area under ROC curve (AUC) of IL-18 and IL-17A in predicting RMPP were 0.85, 0.81, 0.80 and 0.69 in the RMPP group, respectively, with corresponding cut-off values of 472.0 pg/mL, 13.4 pg/mL,389.0 UI/mL, and 251.0 pg/mL, respectively. Conclusions Serum IL-17A≥13.4 pg/mL and IL-18≥472 pg/mL were relatively accurate predictors of refractory mycoplasma pneumonia in children, and IL-18 has higher predictive efficacy.