The Post-Pandemic Return of Mycoplasma pneumoniae: Why Children Matter and What Clinicians Should Know

Mycoplasma pneumoniae infections declined sharply during COVID-19 non-pharmaceutical interventions but have resurged in multiple regions after restrictions were lifted. This narrative Perspective synthesizes recent epidemiologic and molecular observations and emphasizes children as a key reservoir sustaining community transmission. We highlight how asymptomatic carriage and prolonged upper-airway detection complicate interpretation of PCR results, and we discuss the clinical implications of macrolide-resistant M. pneumoniae (MRMP), including pragmatic, age-stratified management considerations. Finally, we outline priorities for surveillance and for translating genomic signals into simplified clinical pathways, particularly in high-MRMP settings.