What is the likelihood of full remission of overactive bladder symptoms caused by Mycoplasma genitalium (M. gen) with antibiotic treatment?

From the Guidelines

The likelihood of full remission of overactive bladder symptoms caused by Mycoplasma genitalium (M. gen) with antibiotic treatment is generally favorable, with azithromycin 500 mg p.o. on day 1 being a recommended treatment option. For M. gen infections, the European Association of Urology guidelines suggest azithromycin as a first-line treatment, with moxifloxacin 400 mg q.d. for 7-14 d as an alternative in cases of macrolide resistance 1. It is essential to note that the guidelines do not specifically address overactive bladder symptoms, but rather focus on the treatment of urethritis caused by M. gen.

The treatment approach for M. gen infections typically involves:

• Azithromycin 500 mg p.o. on day 1, as recommended by the European Association of Urology guidelines 1
• Alternative regimens, such as moxifloxacin 400 mg q.d. for 7-14 d, in cases of macrolide resistance 1
• Completion of the full course of antibiotics, even if symptoms improve early
• Abstaining from sexual activity until treatment is complete
• Ensuring partners are also treated to prevent reinfection

Overactive bladder symptoms may take several weeks to fully resolve after the infection is cleared, as the connection between M. gen and overactive bladder stems from the infection causing urethritis or cervicitis, which can irritate the bladder and trigger overactive bladder symptoms through inflammation of the urogenital tract. If symptoms persist beyond 4-6 weeks after completing appropriate antibiotic therapy, further urological evaluation may be warranted to rule out other causes.

From the Research

Overactive Bladder Symptoms Caused by M. gen

• The likelihood of full remission of overactive bladder symptoms caused by Mycoplasma genitalium (M. gen) with antibiotic treatment is not directly addressed in the provided studies, as they focus on the treatment of M. gen infections in general, rather than specifically on overactive bladder symptoms.
• However, the studies do provide information on the efficacy of different antibiotic treatments for M. gen infections, which may be relevant to the treatment of overactive bladder symptoms caused by M. gen.
• According to the studies, azithromycin has a cure rate of 85-95% in macrolide-susceptible infections 2, while moxifloxacin has a cure rate of 96% (95% confidence interval, 90%-99%) 3.
• Resistance-guided therapy using doxycycline-moxifloxacin or doxycycline-2.5 g azithromycin has been shown to be effective in treating M. gen infections, with cure rates of 92% and 95.7%, respectively 4, 5.
• It is worth noting that the studies do not specifically address the treatment of overactive bladder symptoms caused by M. gen, and therefore, the efficacy of antibiotic treatment for this specific condition is not well established.

Treatment Efficacy

• The efficacy of antibiotic treatment for M. gen infections can vary depending on the specific antibiotic used and the presence of antibiotic resistance.
• Azithromycin has been shown to be effective in treating M. gen infections, but resistance to this antibiotic is increasing 2, 6.
• Moxifloxacin has also been shown to be effective, but resistance to this antibiotic is also increasing 3.
• Resistance-guided therapy using doxycycline-moxifloxacin or doxycycline-2.5 g azithromycin may be a effective approach to treating M. gen infections, especially in cases where antibiotic resistance is suspected 4, 5.

Antibiotic Resistance

• Antibiotic resistance is a significant concern in the treatment of M. gen infections, with macrolide resistance exceeding 50% in many regions 4.
• Quinolone resistance is also increasing, with moxifloxacin resistance reported in several studies 3, 4.
• The use of resistance-guided therapy may help to mitigate the impact of antibiotic resistance on treatment efficacy 4, 5.