Objective To probe the clinical efficacy of different doses of methylprednisolone in the treatment of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. Methods One hundred and fifty-three children with RMPP in our hospital from January 2019 to January 2022 were enrolled，and classified into three groups according to different doses of methylprednisolone，high dose group(10 mg•kg-1•d-1； n = 51)，medium dose group (5 mg•kg-1•d-1； n = 51) and low dose group (2 mg•kg-1•d-1； n = 51). Then the clinical efficacy，time to disappearance of symptoms，levels of inflammatory factors and incidence of adverse effects were compared among the three groups. Results The clinical efficacy rate was 98.04% in high dose group，which was higher than 90.20% in medium dose group and 74.51% in low dose group，with statistical difference (P > 0.05). The disappearance time of fever，cough and lung wet rales among three groups was the shortest in high dose group，followed by medium dose group and low dose group，with statistical difference (P < 0.05). A reduction was detected in serum levels of C-reactive protein (CRP)，interleukin 6 (IL6)，and tumor necrosis factor-α (TNF-α) in all three groups，and the decline in three groups had statistical difference (P < 0.05). The decline in CRP of high dose group yielded no statistical difference with that of medium dose group (P > 0.05)，and no statistical difference was found in the decline in serum IL-6 and TNF-α levels between medium and low dose groups (P > 0.05). The total adverse reaction rate was 7.84% in high dose group，11.76% in medium dose group and 9.80% in low dose group，with no statistical difference (P > 0.05). Conclusion Compared to low and medium dose of methylprednisolone，high doses of methylprednisolone was more effective and safe in the treatment of RMPP in children in terms of the shorter relief time and obvious attenuation of inflammatory response.