Objective To evaluate the efficacy of azithromycin in the treatment of mycoplasma pneumoniae pneumonia(MPP),identify the independent risk factors affecting the efficacy of azithromycin,and establish a clinical prediction model for the efficacy of az-ithromycin in order to provide precise reference for clinical decision-making.Methods 157 pediatric patients with MPP were selected.The data of clinical,laboratory and imaging were collected for comparison.Logistic regression analysis was used to identify the risk fac-tors affecting the efficacy of azithromycin in treating MPP,and a clinical prediction nomogram was constructed to assess azithromycin effi-cacy.Results The average age of the children was(7.8±2.5)years,and their average weight was(27.1±9.6)kg.Azithromycin was effective in 95 cases(60.5%)and ineffective in 62 cases(39.5%).The results of univariate analysis and multivariate logistic regres-sion model indicated that the number of MP-resistant gene sequences,duration of fever,age,length of hospital stay,and alveolar lavage fluid were significantly associated with azithromycin efficacy.The final established nomogram model included these five variables and had a concordance index of 0.852 and an AUC of 0.867(95%CI:0.795~0.923).The sensitivity of the model was 0.895,specificity was 0.800,and decision curve analysis suggested that when the threshold probability was between 0.00 and 1.00,the net benefit rate predic-ted by the model exceeded 5.6%.Conclusion The nomogram model based on the number of MP-resistant gene sequences,duration of fever,age,length of hospital stay,and alveolar lavage fluid has good clinical application value for predicting the efficacy of azithromycin treatment in pediatric patients of MPP.