From the Guidelines
For patients allergic to doxycycline who require treatment for Mycoplasma genitalium infection, the recommended alternative is azithromycin, with a standard regimen of 500 mg orally on day 1, followed by 250 mg daily for days 2-5 (a 5-day course) 1. This recommendation is based on the most recent guidelines from the European Association of Urology, which suggest azithromycin as the first-line treatment for M. genitalium infection, especially in cases where doxycycline is not suitable due to allergy 1. The choice of azithromycin is crucial due to the high rates of antimicrobial resistance in M. genitalium, including resistance to macrolides, which necessitates an extended treatment course rather than a single dose 1. In cases where azithromycin treatment fails or if macrolide resistance is suspected, moxifloxacin 400 mg orally once daily for 7-14 days is the recommended next option 1. It is essential to note that M. genitalium lacks a cell wall, making it inherently resistant to certain antibiotics like penicillins and cephalosporins, and its tendency to develop resistance to many other antibiotics complicates treatment 1. Key considerations in managing M. genitalium infection include:
- Testing for cure 3-4 weeks after completing treatment to address the high rates of antimicrobial resistance 1.
- Treating sexual partners to prevent reinfection 1.
- Advising patients to abstain from sexual activity until both they and their partners have completed treatment and symptoms have resolved 1.
From the Research
Treatment Options for M. genitalium Infection
In patients with an allergy to Doxycycline, the following treatment options are available for M. genitalium infection:
- Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral) as first-line therapy 2, 3
- Moxifloxacin 400 mg od for 7-10 days (oral) as second-line therapy 2, 3, 4
- Pristinamycin 1 g four times daily for 10 days (oral) with a cure rate of around 75-90% 2, 3
- Sitafloxacin 100 mg twice daily for 7 days (oral) for macrolide-resistant infections 5
Considerations for Treatment
When treating M. genitalium infection, it is essential to consider the following:
- Macrolide resistance is increasing, and resistance-guided therapy is recommended 3, 6, 5
- Azithromycin has a high cure rate, but extended courses may be more effective 2, 3, 6
- Moxifloxacin is effective, but resistance is increasing, and its use should be monitored 2, 3, 4
- Doxycycline has a low cure rate, but may be used as third-line therapy or in combination with other antibiotics 2, 3, 5
Special Considerations
In cases of complicated M. genitalium infection, such as pelvic inflammatory disease (PID) or epididymitis, moxifloxacin 400 mg od for 14 days (oral) is recommended 2, 3