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肺炎支原体(mycoplasma pneumoniae，MP)是儿童社区获得性肺炎最常见的病原体，大环内酯类是肺炎支原体肺炎(mycoplasma pneumoniae pneumonia，MPP)治疗的一线药物。近年来随大环内酯类耐药MP(macrolide resistant MP，MRMP)明显增多，难治性MPP(refractory MPP，RMPP)和暴发性MPP(fulminant MPP，FMPP)明显增加，成为引起临床关注的问题。本文对近年有关MRMP、RMPP和FMPP的相关研究进行了梳理，就MRMP、RMPP和FMPP的诊断和治疗进行了详细讨论。优先考虑选择敏感抗菌药物并及早开始有效抗菌药物治疗、适当使用免疫调节和抗炎治疗、积极治疗并发症和混合感染是RMPP和FMPP治疗的关键。“,”Mycoplasma pneumoniae (MP) is the most common pathogens of community-acquired pneumonia in children.Macrolides are the first-line antibiotics for mycoplasma pneumoniae pneumonia (MPP) treatment.However, in recent years, with macrolide resistant MP (MRMP) becoming prevalent, refractory MPP (RMPP) and fulminant MPP (FMPP) increased significantly.It has become a hot issue for clinicians.This paper reviewed the recent studies on MRMP, RMPP and FMPP, discussed the diagnosis and treatment options for MRMP, RMPP and FMPP in detail.Prioritizing the selection of sensitive antibiotics and early initiation of effective antibiotic therapy, appropriate use of immunoregulatory and anti-inflammatory therapies, and aggressive treatment of complications and co-infections are the keys to RMPP and FMPP therapy.