Mycoplasma pneumoniae (MP) is the commonest respiratory pathogen and is a frequent cause of community acquired pneumonia (CAP) in children more than five years. Rarely MP may cause a severe and complicated respiratory disease. The drug of choice for MP infection is macrolide antibiotics and recently macrolide resistant strains of MP have been reported in Asian counties. Here we report a case of eight years immunocompetent boy who developed bilateral empyema due to MP and streptococcus pneumoniae as a mixed infection and MP turned out to be macrolide resistant which was successfully identified and treated well with non-macrolide antibiotic with good outcome.