From the Guidelines
The recommended treatment for Mycoplasma genitalium infections is azithromycin 500 mg p.o. on day 1, with alternative regimens including moxifloxacin 400 mg q.d. for 7-14 days in cases of macrolide resistance. This approach is based on the most recent guidelines from the European Association of Urology, which suggest azithromycin as the first-line treatment for M. genitalium infections 1. The guidelines also recommend moxifloxacin as an alternative regimen for patients with macrolide-resistant M. genitalium.
Key considerations in the treatment of M. genitalium infections include:
- The use of azithromycin as the first-line treatment, with a dosage of 500 mg p.o. on day 1 1
- The consideration of moxifloxacin as an alternative regimen for patients with macrolide-resistant M. genitalium, with a dosage of 400 mg q.d. for 7-14 days 1
- The importance of treating sexual partners to prevent reinfection, as recommended by the Centers for Disease Control and Prevention 1
- The need for patients to abstain from sexual activity until they and their partners complete treatment and symptoms resolve, as recommended by the Centers for Disease Control and Prevention 1
It is essential to note that M. genitalium lacks a cell wall, making it naturally resistant to beta-lactam antibiotics like penicillins and cephalosporins. The extended azithromycin regimen is preferred over the single 1-gram dose to reduce the development of resistance. Testing for cure is recommended 3-4 weeks after completing treatment, particularly in cases of persistent symptoms or high risk of reinfection.
The European Association of Urology guidelines provide the most up-to-date and evidence-based recommendations for the treatment of M. genitalium infections, and should be consulted for further guidance on treatment and management 1.
From the Research
Treatment Options for Mycoplasma genitalium Infections
- The recommended first-line treatment for Mycoplasma genitalium infections is azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral) 2, 3.
- However, due to increasing macrolide resistance, the cure rate of azithromycin has decreased, and moxifloxacin is used as a second-line treatment 4, 2, 3.
- Moxifloxacin 400 mg od for 7-10 days (oral) is recommended for second-line treatment and for uncomplicated macrolide-resistant M. genitalium infection 2, 3.
- For persistent M. genitalium infection after azithromycin and moxifloxacin, doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40-70%, and pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75% 2, 3.
- Complicated M. genitalium infection (PID, epididymitis) should be treated with moxifloxacin 400 mg od for 14 days 2, 3.
Resistance and Treatment Failure
- Macrolide resistance is increasing, with a reported rate of 55.5% in some regions 5.
- Fluoroquinolone resistance is also a concern, with a reported rate of 20.6% in some studies 5.
- Treatment failure is more likely in patients with persistent M. genitalium infection, highlighting the importance of follow-up and test of cure 6.
- Resistance-guided therapy is recommended to improve treatment outcomes and reduce the risk of resistance selection 3, 5.
Diagnostic Testing and Treatment Guidelines
- Diagnostic testing for M. genitalium should include investigation for macrolide resistance mutations 2, 3.
- Therapy for M. genitalium is indicated if M. genitalium is detected, and treatment should be guided by resistance testing and clinical symptoms 2, 3.
- Strict adherence to testing criteria and local resistance testing is recommended to improve treatment outcomes and reduce the risk of resistance selection 5.