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OBJECTIVE To investigate the efficacy and adverse reactions of methylprednisolone plus azithromycin in the treatment of children with refractory mycoplasma pneumoniae pneumonia (RMPP) and its effect on fractional exhaled nitric oxide (FeNO) and peripheral blood eosinophils (EOS). STUDY DESIGN Comparative study. PLACE AND DURATION OF STUDY Daqing Oilfield General Hospital, China, from June 2019 to January 2021. METHODOLOGY A total of 102 children with RMPP were randomly divided into Group A (n = 51) and Group B (n = 51) by the random number table. Group A was treated with azithromycin alone, and Group B was treated with methylprednisolone plus azithromycin. The efficacy, adverse reactions, FeNO and EOS levels were compared. RESULTS The total effective rate of treatment in Group B was higher than that in Group A (p=0.006). Time of cough disappearance, lung shadow disappearance, defervescence and hospitalisation in Group B was shorter than that in Group A (p=0.033, 0.008, 0.004 and <0.001, respectively). After treatment, the FeNO and EOS levels in Group B were lower than those in Group A (both p <0.001). CONCLUSION The efficacy of methylprednisolone plus azithromycin in treatment of RMPP is better than azithromycin alone. The former can reduce the levels of FeNO and EOS more effectively than the latter. Key Words: Refractory mycoplasma pneumoniae pneumonia (RMPP), Methylprednisolone, Azithromycin, Fractional exhaled nitric oxide (FeNO), Eosinophils (EOS).