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.

中文翻译：

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抗性指导的顺序治疗生殖器支原体感染的结果：一项前瞻性评估。

背景

生殖支原体中大环内酯类和喹诺酮类药物的耐药性上升需要新的治疗方法。我们通过大环内酯耐药性试验评估了生殖器支原体顺序抗菌治疗的效果。

方法

2016年中，墨尔本性健康中心因非淋菌性尿道炎，宫颈炎和直肠炎从阿奇霉素改为强力霉素（每天两次，每日两次，每次100毫克）。通过聚合酶链反应对病例进行生殖器支原体和大环内酯类耐药突变（MRM）的检测。强力霉素后，MRM阴性感染直接接受2.5 g阿奇霉素（1 g，然后每天500 mg，共3天），MRM阳性感染接受西他沙星（100 mg，每天两次，共7天）。在第二种抗生素后14-90天进行了治愈和再感染风险测试的评估。

结果

从2016年6月20日至2017年5月15日，诊断出244例可诊断的生殖器支原体感染（52位女性，68位异性恋男性，124位与男性发生性关系的男性），其中167例检出了MRM（68.4％[95％置信区间{CI}， 62.2％–74.2％]）。用强力霉素治疗可将细菌载量平均降低2.60 log ₁₀（n = 56; P <.0001）。在77例MRM阴性感染中，有73例发生了微生物学治愈（94.8％[95％CI，87.2％–98.6％]），在167例MRM阳性感染中有154例（92.2％[95％CI，87.1％–95.8％]） 。对大环内酯类药物的选择仅在易感大环内酯类药物的76例中有2例（2.6％[95％CI，.3％–9.2％]）发生。

结论

在高水平的抗生素耐药性的情况下，从阿奇霉素转为强力霉素来推定生殖器支原体，然后进行耐药指导治疗，治愈了≥92％的感染，并且很少选择大环内酯类耐药。