Abstract: Macrolide antibiotics are the first-line drugs for the treatment of Mycoplasma pneumoniae (MP)infections in children, but with the increased use of macrolides, the detection rate of resistant strains of MP to macrolides has increased rapidly. Among the studies related to the mechanisms of drug resistance, the study of drug targets has been the most extensive and intensive, with mutations in the 23S rRNA gene being studied most extensively. The emergence of drug resistance affects the therapeutic efficacy of drugs, and the mechanisms of drug resistance need to be explored to adjust the choice of therapeutic agents in order to achieve higher therapeutic efficacy. This paper reviewed the mechanisms of action of macrolides and the mechanisms of resistance to macrolides by MP.