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Reports from China about severe pneumonia in children and overcrowded hospitals in October 2023 reminded of the COVID-19 pandemic. At the request of the World Health Organization (WHO), China provided epidemiological and clinical data in November 2023, according to which the current increase in illnesses is due to an increased circulation of known pathogens. By far the most frequently detected pathogen, Mycoplasma pneumoniae, is known to cause pneumonia in children. The course is usually mild, nonetheless a high number of serious cases have been reported from China [1]. In severe cases or extrapulmonary manifestations, antibiotic therapy should be considered. For macrolide antibiotics, the substance group of first choice, resistance rates in Asia are up to 90 %, which could explain the severe courses caused by inadequate antibiotic therapy [2]. Alternative antibiotics are associated with severe side effects and are rarely administered. If there is no response to treatment, pathogens such as respiratory syncytial virus (RSV), SARS-CoV-2 or influenza should be consider ed in the differential diagnosis. In Germany, resistance to macro lides is currently < 10 %, which means that treatment is sufficiently safe [3]. Currently there are no indications of increased virulence of the pathogen. [ABSTRACT FROM AUTHOR]

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