Objective: To explore the clinical effect of combining methylprednisolone sodium succinate for injection on the basis of azithromycin treatment for lobar pneumonia in children. Method: Sixty children with lobar pneumonia admitted to our hospital from August 2023 to May 2025 were selected as the research subjects. The research subjects were divided into the control group and the observation group according to the random number table method, with 30 cases in each group. Both groups received basic treatment. On this basis, the control group was treated with azithromycin, while the observation group was treated with azithromycin combined with methylprednisolone sodium succinate for injection. The clinical symptom relief time, pulmonary function [peak expiratory flow (PEF), forced expiratory volume in the first second (FEV1)], inflammatory factor [interleukin-6 (IL-6), procalcitonin (PCT)] levels, Blood routine [White blood Cell Count (WBC), Neutrophil Count (NEUT)] and adverse reactions of the two groups were analyzed and compared. Results: The time for fever reduction, cough relief, disappearance of lung rales, absorption of lung shadows, and hospital stay in the observation group were significantly shorter than those in the control group (P < 0.05). After 5 days of treatment, the PEF and FEV1 in both groups were significantly increased compared with those before treatment, and the levels of PEF and FEV1 in the observation group were significantly higher than those in the control group (P < 0.05). After 5 days of treatment, the levels of serum CRP, IL-6 and PCT in both groups were significantly lower than those before treatment, and the levels of serum CRP, IL-6 and PCT in the observation group were significantly lower than those in the control group (P < 0.05). After 5 days of treatment, the levels of WBC and NEUT in both groups were significantly lower than those before treatment, and the levels of WBC and NEUT in the observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P < 0.05). Conclusion: The combination of azithromycin treatment with methylprednisolone sodium succinate for injection in children with lobar pneumonia can promote the relief of clinical symptoms, improve lung function, alleviate inflammation, improve blood routine indicators, and has good safety.