〔Abstract〕 Objective To analyze the effect of methylprednisolone sodium succinate combined with azithromycin on refractory mycoplasma pneumonia in children. Methods A total of 64 children with refractory mycoplasma pneumonia admitted to Huai 'an Maternal and Child Health Care Hospital from March 2020 to August 2021 were randomly divided into an observation group (treated with methylprednisolone sodium and azithromycin) and a control group (treated with azithromycin) with 32 cases in each group. The clinical efficacy and improvement of clinical symptoms, the changes of C-reactive protein (CRP), interleukin-1 (IL-1), interleukin-6 (IL-6) and other inflammatory factors before and after treatment, and the occurrence of adverse reactions during treatment were compared between the two groups. Results The total effective rate of the observation group was 96.88 %, significantly higher than 81.25 % of the control group, and the difference was statistically significant (P < 0.05). The time of lung rales disappearance, cough disappearance, fever remission and hospital stay in the observation group were shorter than those in the control group, and the differences were statistically significant (P < 0.05). Compared with before treatment, the serum levels of CRP, IL-1 and IL-6 in the two groups were decreased after clinical treatment, and the decrease was more obvious in the observation group, the differences were statistically significant (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion Compared with azithromycin alone, the combination of methylprednisolone sodium succinate has a better therapeutic effect on refractory mycoplasma pneumonia, which can further accelerate the disappearance of clinical symptoms and recovery of body temperature, narrow the scope of the focus, and effectively reduce the level of inflammatory factors in the body of the children, reduce the inflammatory response, and promote the recovery of the children.