Efficacy of systemic glucocorticoids in pediatric Mycoplasma pneumoniae infection

Aims: This review aimed to evaluate the clinical efficacy and safety of systemic glucocorticoids in children with Mycoplasma pneumoniae pneumonia (MPP), with particular focus on severe (SMPP) and refractory (RMPP) cases, based on prospective studies published between 2015 and 2025. Methods: A structured literature search was conducted using PubMed and Google Scholar. Only English-language prospective studies involving pediatric patients were included. Eight studies met the eligibility criteria. Data were extracted and summarized thematically. No formal bias assessment was performed, but study limitations were analyzed narratively. Geographic distribution, study design, and outcome heterogeneity were taken into account. Results: Combination therapy with glucocorticoids and antibiotics was associated with improved clinical outcomes in MPP, including reduced fever duration, improved pulmonary function, and lower inflammatory marker levels (CRP, IL-6, TNF-α). Intravenous methylprednisolone was the most commonly used steroid (1–2 mg/kg/day, up to 10 mg/kg/day in severe cases). Early administration (within 24–36 hours of hospital admission) was linked to better outcomes. No significant increase in adverse events was reported. One study suggested potential cost-effectiveness in RMPP. However, most data originated from East and Southeast Asia, limiting generalizability to European populations. Conclusions: Glucocorticoid therapy may be beneficial in pediatric MPP, especially in severe and refractory forms. However, current evidence is limited by small sample sizes, heterogeneity in interventions, and regional concentration of studies. No standardized protocol for dosing, duration, or patient selection exists. High-quality, geographically diverse randomized controlled trials are urgently needed to support clinical decision-making in non-Asian populations.