Background Mycoplasma pneumoniae (M.pneumoniae) is one of the common pathogens causing atypical pneumonia.In recent years,resistance to macrolides has become more common,especially in China.Previous studies have confirmed that the mutation at position 2063 in domain V of the 23S rRNA is the most prevalent,followed by the mutation at position 2064.Reported molecular detection methods for the identification of these mutations include direct sequencing,restriction fragment length polymorphism analysis,real-time polymerase chain reaction (PCR) with high-resolution melt analysis,and nested PCR-linked with capillary electrophoresis,etc.The most commonly used method for monitoring resistance-conferring mutations in M.pneumoniae is direct DNA sequencing of PCR or nested PCR products.However,these methods are time-consuming,labor-intensive or need expensive equipments.Therefore the development of rapid and sensitive methods is very important for monitoring the resistance globally.Methods In this study,we reported a fast and cost-effective method for detecting 2063 and/or 2064 macrolide resistant mutations from specimens using a modified allele-specific PCR analysis,and all results were compared with the sequencing data.We also analyzed the clinical courses of these samples to confirm the modified allele-specific PCR results.Results Among 97 M.pneumoniae specimens,88 were found to possess mutations by this method,and all modified allele-specific PCR analysis results were consistent with the sequencing data.The data of the clinical courses of these 97cases showed that they suffered from severe pneumonia.Erythromycin showed better efficacy on cases from which no macrolide resistance mutation was found on their specimens.However,in some cases from which mutations were detected,erythromycin monotherapy had poor efficacy,and on these patients severe symptoms improved only when azithromycin was added to the treatment.Conclusions The drug-resistant M.pneumoniae is very common in Beijing,China.Our modified allele-specific PCR analysis can identify erythromycin resistant mutations more rapidly from specimens than any other method currently available.Erythromycin is still effective for treating patients infected with the mutation negative M.pneumoniae,but this treatment fails to work on mutant organisms.This method can facilitate clinicians in selecting appropriate therapy within short timescales.