What is the treatment for Ureaplasma in urine?

Treatment for Ureaplasma in Urine

Doxycycline 100 mg orally twice daily for 7 days is the first-line treatment for Ureaplasma urealyticum infections in urine. 1

First-Line Treatment Options

• Doxycycline: 100 mg orally twice daily for 7 days

  • Maintains highest susceptibility rates worldwide
  • Recommended by both European Urology and CDC guidelines 1

• Alternative first-line: Azithromycin 1-1.5 g orally as a single dose

  • Offers better compliance due to single-dose regimen
  • Similar effectiveness to doxycycline in clinical trials
  • Preferred when compliance with multi-day regimens is a concern 1

Treatment Considerations

Partner Treatment

• Sexual partners should be treated simultaneously, even without testing
• Partners who had sexual contact within the preceding 60 days should be referred for evaluation and treatment
• Failure to treat partners is a major cause of reinfection and treatment failure 1

Sexual Activity

• Patients should abstain from sexual intercourse until:
  • 7 days after therapy is initiated
  • Symptoms have completely resolved
  • All partners have been treated 1

Alternative Treatment Options

For patients who cannot tolerate first-line agents:

• Erythromycin
• Ofloxacin
• Levofloxacin 1

For resistant cases:

• Moxifloxacin 400 mg daily for 7-14 days 1

Management of Persistent Infection

If symptoms persist after initial treatment:

1. Retreatment with the initial regimen or an alternative regimen for 14 days
2. For tetracycline-resistant strains, consider erythromycin for 14 days
3. Consider metronidazole 2 g orally in a single dose or tinidazole 2 g orally in a single dose, plus azithromycin 1 g (if not used initially) 1

Antimicrobial Resistance Patterns

• Low resistance rates have been observed in college-aged women with first-time UTIs 2
• However, resistance patterns vary regionally:
  • Some studies have identified tetracycline resistance in over one-third of Ureaplasma isolates in certain regions 2
  • Resistance mechanisms include tetM gene (tetracycline resistance) and S83W mutation in parC gene (quinolone resistance) 2

Follow-up Recommendations

• No routine follow-up is needed if symptoms resolve
• Patients should return for evaluation if symptoms persist or recur after completing therapy 1

Special Considerations

Immunocompromised Patients

• May require more aggressive treatment and monitoring
• Severe disseminated infections can occur
• Should receive the same initial treatment regimen as immunocompetent patients 1

Pregnancy and Infertility

• Ureaplasma has been associated with adverse pregnancy outcomes
• Pregnancies have been observed in patients who became Ureaplasma negative after doxycycline therapy 3

Urinary Stones

• Ureaplasma is a urease-producing organism and can contribute to struvite calculi formation
• Should be considered in patients with recurrent stones or sterile pyuria 4

Common Causes of Treatment Failure

• Failure to treat partners
• Inadequate duration of therapy
• Misdiagnosis
• Antimicrobial resistance
• Premature resumption of sexual activity 1