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Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation
Open accessAbstract
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: In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. 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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Research has shown that doxycycline may have the added benefit of reducing the bacterial load of M. genitalium before administering azithromycin.
“Moreover, research has shown that doxycycline may have the added benefit of reducing the bacterial load of M. genitalium before administering azithromycin (35).”
Some countries are starting to see important gains in terms of greater uptake of syphilis testing and increased treatment coverage.
“As a result, some countries are starting to see important gains in terms of greater uptake of syphilis testing and increased treatment coverage (49).”
From Updated recommendations for the treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum (syphilis) and new recommendations on syphilis testing and partner services (2024) · cites this paper as [49]
The Methods and Results describe resistance-guided treatment and cure of Mycoplasma genitalium infections at a Melbourne clinic. A search for syphilis found no passage addressing syphilis-testing uptake or treatment coverage across countries. (LLM, conf=0.78)
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Research works printed but not linked: 27
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Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 3,018
Machalek, D. A., Tao, Y., Shilling, H., Jensen, J. S., Unemo, M., Murray, G., Chow, E. P. F., Low, N., Garland, S. M., Vodstrcil, L. A., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30154-7 · Cited by 273
Self-citation
Metadata
- Authors
- Read, T. R. H., Fairley, C. K., Murray, G. L., Jensen, J. S., Danielewski, J., Worthington, K., Doyle, M., Mokany, E., Tan, L., Chow, E. P. F., Garland, S. M., & Bradshaw, C. S.
- Affiliations
- The Alfred Hospital (AU)
- Royal Children's Hospital (AU)
- Statens Serum Institut, Copenhagen, Denmark
- Royal Women's Hospital (AU)
- SpeeDx Pty Ltd, Eveleigh, New South Wales
- Corresponding author
- Read, Tim R H
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-06-05
- Volume
- 68
- Issue
- 4
- Pages
- 554-560
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC6355821
- OpenAlex
- W2807449723
- Cited by
- 216
- References
- 0
- Citations by year
- 2026: 13 · 2025: 27 · 2024: 31 · 2023: 27 · 2022: 16 · 2021: 24 · 2020: 36 · 2019: 37 · 2018: 5
- FWCI
- 20.61
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Infectious Diseases (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Monash University Research Portal (Monash University) (submittedVersion, cc-by)
- Funders
- National Health and Medical Research Council (1091536, 1091226)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Life Sciences › Immunology and Microbiology › Microbiology › Microbial infections and disease research
- Health Sciences › Medicine › Infectious Diseases › Antibiotic Use and Resistance
- Keywords
- Mycoplasma genitalium, macrolide resistance, quinolone resistance, doxycycline, azithromycin, sitafloxacin, non-gonococcal urethritis, cervicitis, proctitis, test of cure, reinfection, sexually transmitted infections, bacterial load
- MeSH terms
- Adult, Anti-Bacterial Agents, Female, Humans, Male, Mycoplasma Infections, Prospective Studies, Treatment Outcome, Drug Monitoring, Macrolides, Drug Resistance, Bacterial, Mycoplasma genitalium, Young Adult
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