Mycoplasma pneumoniae has traditionally been recognised as a significant causative agent of community-acquired pneumonia in school-aged children. However, recent epidemiological shifts, particularly following the COVID-19 pandemic, have altered the clinical presentation and management challenges associated with this pathogen. This comprehensive review examines contemporary issues in the diagnosis and treatment of M. pneumoniae infections in children, with particular emphasis on the increasing prevalence of macrolide resistance and extrapulmonary manifestations. The post-pandemic resurgence of M. pneumoniae infections has been characterised by more severe clinical presentations, including a higher incidence of severe M. pneumoniae pneumonia with complications such as pleural effusion, as well as an increased frequency of extrapulmonary manifestations, notably mucocutaneous and neurological disorders. Importantly, up to 25% of paediatric patients with M. pneumoniae infection develop dermatological manifestations, including M. pneumoniae-induced rash and mucositis. Concurrently, rising macrolide resistance rates have compromised the efficacy of first-line treatments, necessitating alternative therapeutic approaches such as tetracyclines in refractory cases. This review synthesises current evidence regarding the evolving epidemiology, clinical presentation, diagnostic approaches, and therapeutic strategies for M. pneumoniae infections in the paediatric population, highlighting the need for increased clinical vigilance and potentially revised treatment algorithms in the face of this common but increasingly complex pathogen.

Mycoplasma pneumoniae, macrolide resistance, Mycoplasma pneumoniae-induced rash and mucositis (MIRM), extrapulmonary manifestations, severe Mycoplasma pneumoniae pneumonia (SMPP)