Abstract | Background: Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. Methods: Results: Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4% [95% confidence interval {CI}, 62.2%-74.2%]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8% [95% CI, 87.2%-98.6%]) and in 154 of 167 MRM-positive infections (92.2% [95% CI, 87.1%-95.8%]). Selection of macrolide resistance occurred in only 2 of 76 (2.6% [95% CI, .3%-9.2%]) macrolide-susceptible infections. Conclusions: In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance.
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Authors | Tim R H Read, Christopher K Fairley, Gerald L Murray, Jorgen S Jensen, Jennifer Danielewski, Karen Worthington, Michelle Doyle, Elisa Mokany, Litty Tan, Eric P F Chow, Suzanne M Garland, Catriona S Bradshaw |
Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
(Clin Infect Dis)
Vol. 68
Issue 4
Pg. 554-560
(02 01 2019)
ISSN: 1537-6591 [Electronic] United States |
PMID | 29873691
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Bacterial Agents
- Macrolides
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Topics |
- Adult
- Anti-Bacterial Agents
(pharmacology, therapeutic use)
- Drug Monitoring
(methods)
- Drug Resistance, Bacterial
- Female
- Humans
- Macrolides
(pharmacology, therapeutic use)
- Male
- Mycoplasma Infections
(drug therapy, microbiology)
- Mycoplasma genitalium
(drug effects, isolation & purification)
- Prospective Studies
- Treatment Outcome
- Young Adult
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