From the Guidelines
The most effective treatment for UTI due to Mycoplasma is azithromycin 500 mg p.o. on day 1, as recommended by the European Association of Urology guidelines 1. This treatment approach is based on the latest guidelines from the European Association of Urology, which suggest azithromycin as the first-line treatment for Mycoplasma genitalium 1. The dosage and duration of azithromycin treatment are crucial, with a recommended dose of 500 mg p.o. on day 1 1. Some key points to consider when treating UTI due to Mycoplasma include:
- The use of alternative regimens, such as moxifloxacin 400 mg q.d. 7–14 d, in cases of macrolide resistance 1
- The importance of completing the full course of antibiotics, even if symptoms improve before completion
- The need for increased fluid intake to help flush bacteria from the urinary tract
- The potential for antibiotic resistance, particularly to fluoroquinolones, and the need for follow-up testing if symptoms persist after treatment 1.
From the Research
Treatment of UTI due to Mycoplasma
- The treatment of Mycoplasma genitalium infections is indicated if the infection is detected 2.
- Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections, but resistance is increasing 2.
- Doxycycline has a cure rate of 30-40%, but resistance is not increasing 2.
- Moxifloxacin can be used as second-line therapy, but resistance is increasing 2, 3.
- The recommended treatment regimens for uncomplicated M. genitalium infection are:
- Resistance-guided therapy using doxycycline followed by azithromycin or moxifloxacin has been shown to be effective in treating M. genitalium infections, with cure rates of 92-95% 3.
- The efficacy of azithromycin for the treatment of genital M. genitalium has decreased over time, with a pooled microbial cure rate of 77.2% (95% CI, 71.1%-83.4%) in a systematic review and meta-analysis 4.
- A 5-day regimen of azithromycin may be more effective and less likely to cause resistance than a single 1g dose 5.