From the Guidelines
The treatment for Mycoplasma genitalium infection is Azithromycin 500 mg p.o. on day 1, with an alternative regimen of Moxifloxacin 400 mg q.d. for 7-14 days in cases of macrolide resistance.
Treatment Options
- First-line treatment: Azithromycin 500 mg p.o. on day 1 1
- Alternative treatment for macrolide-resistant M. genitalium: Moxifloxacin 400 mg q.d. for 7-14 days 1
Rationale
The European Association of Urology guidelines suggest Azithromycin as the first-line treatment for M. genitalium infection, with Moxifloxacin as an alternative in cases of macrolide resistance 1. This is supported by previous guidelines from MMWR Recommendations and Reports, which also recommend Azithromycin as a effective treatment for M. genitalium infections 1.
Important Considerations
- Treatment should be initiated as soon as possible after diagnosis 1
- Single-dose regimens have the advantage of improved compliance and directly observed treatment 1
- Medications should be dispensed on-site in the clinic, and the first dose should be directly observed to maximize compliance 1
From the Research
Treatment Options for Mycoplasma genitalium Infection
The treatment for Mycoplasma genitalium infection includes:
- Azithromycin, which has a cure rate of 85-95% in macrolide-susceptible infections 2, 3, 4
- An extended course of azithromycin, which appears to have a higher cure rate than a single-dose regimen 2, 3
- Moxifloxacin, which can be used as second-line therapy, but resistance is increasing 2, 3, 5, 4
- Doxycycline, which has a cure rate of 30-40%, but resistance is not increasing 2, 5, 4
- Pristinamycin, which has a cure rate of around 75% 4
Recommended Treatment Regimens
The recommended treatment regimens for Mycoplasma genitalium infection are:
- Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral) for uncomplicated infections without macrolide resistance mutations or resistance testing 4
- Moxifloxacin 400 mg od for 7 days (oral) as second-line therapy or for uncomplicated macrolide-resistant infections 4
- Doxycycline or minocycline 100 mg bid for 14 days (oral) as third-line therapy for persistent infections after azithromycin and moxifloxacin 4
- Pristinamycin 1 g qid for 10 days (oral) as an alternative third-line therapy 4
Resistance-Guided Therapy
Resistance-guided therapy is recommended, which involves testing for macrolide resistance mutations and adjusting treatment accordingly 3, 4. This approach has been shown to be effective in achieving high cure rates, with a pooled cure rate of 95.7% (95% CI, 91.6-97.8) in one study 3.