Purpose: This study was performed to investigate differences in clinical, laboratory, and radiologic features of clinical course between macrolide-resistant Mycoplasma pneumoniae (MRMP) and macrolide-sensitive Mycoplasma pneumoniae (MSMP) pneumonia in children. Methods: A total of 146 children hospitalized with Mycoplasma pneumoniae (MP) pneumonia in a tertiary hospital were enrolled in this study. Information on the characteristics was retrospectively obtained using electronic medical records. Results: The duration of fever and hospitalization was significantly longer and respiratory virus coinfection was more common in the MRMP group than in the MSMP group (47.0% vs. 24.1%, P=0.026). No significant intergroup difference in the laboratory findings, except monocytes (%), was observed. The proportion of patients with pneumonic lesions involving more than half of the whole lung was higher (28.2% vs. 10.3%), with a poorer response to the stepwise treatment for MP pneumonia, in the MRMP group than in the MSMP pneumonia group. MRMP pneumonia in children may be associated with a higher disease burden than MSMP pneumonia. Conclusion: MRMP pneumonia in children might be associated with a more increased disease burden than MSMP pneumonia. This study suggested the need of distinguished ...