From the Guidelines
Treatment of asymptomatic Ureaplasma (Ureaplasma urealyticum) infection is not recommended. According to the most recent and highest quality study, asymptomatic bacteriuria, which includes Ureaplasma, should only be treated in cases of proven benefit for the patient to avoid the risk of selecting antimicrobial resistance and eradicating a potentially protective strain 1.
Rationale for Not Treating Asymptomatic Ureaplasma
- Asymptomatic Ureaplasma is considered part of the normal genital flora in many sexually active individuals, and treating asymptomatic colonization has not been shown to improve health outcomes.
- The spectrum of bacteria in asymptomatic bacteriuria is similar to species found in uncomplicated or complicated UTIs, depending on the presence of risk factors.
- Clinical studies have shown that asymptomatic bacteriuria may protect against superinfecting symptomatic UTI.
Exceptions to Not Treating Asymptomatic Ureaplasma
- Treatment should be reserved for symptomatic infections or specific clinical scenarios such as recurrent urethritis, cervicitis, pelvic inflammatory disease, or in preparation for certain urological or gynecological procedures.
- Pregnant women with asymptomatic bacteriuria may benefit from treatment to prevent adverse pregnancy outcomes.
Treatment Options
- When treatment is indicated, doxycycline 100 mg twice daily for 7 days is the first-line therapy.
- Alternative regimens include azithromycin 1 gram as a single dose or 500 mg on day 1 followed by 250 mg daily for 4 more days.
- Fluoroquinolones like moxifloxacin 400 mg daily for 7-14 days may be used for resistant cases.
Importance of Judicious Antibiotic Use
- Antimicrobial use drives antimicrobial resistance in the community, as well as in the individual treated.
- Antimicrobial stewardship programs have identified the treatment of asymptomatic bacteriuria as an important contributor to inappropriate antimicrobial use, which promotes resistance 1.
From the Research
Treatment of Asymptomatic Ureaplasma Infection
- The provided studies do not directly address the treatment of asymptomatic Ureaplasma infection, but rather focus on the treatment of symptomatic infections and the antimicrobial susceptibility of Ureaplasma urealyticum 2, 3, 4, 5, 6.
- However, it can be inferred that treatment of asymptomatic Ureaplasma infection may not be recommended, as the studies suggest that treatment should be targeted towards symptomatic patients or those with confirmed infections 2, 3.
- The studies do provide information on the antimicrobial susceptibility of Ureaplasma urealyticum, which can inform treatment decisions for symptomatic infections 4, 5, 6.
- For example, Ureaplasma urealyticum has been shown to be susceptible to azithromycin, doxycycline, and other antibiotics, but resistance to these antibiotics has also been reported 4, 5, 6.
Antimicrobial Susceptibility
- Ureaplasma urealyticum has been shown to be susceptible to various antibiotics, including azithromycin, doxycycline, and tetracyclines 4, 5, 6.
- However, resistance to these antibiotics has also been reported, particularly to quinolones and macrolides 4, 5, 6.
- The biovar of Ureaplasma urealyticum can also affect its antimicrobial susceptibility, with biovar 1 being more susceptible to certain antibiotics than biovar 2 6.
Clinical Implications
- The treatment of Ureaplasma infection should be guided by antimicrobial susceptibility testing and clinical experience 2, 3, 4, 5, 6.
- Prompt diagnosis and initiation of appropriate antibiotic therapy are essential to prevent long-term complications of Ureaplasma infections 4.
- Further research is needed to determine the optimal treatment approach for asymptomatic Ureaplasma infection, as well as to develop effective strategies for preventing the emergence of drug-resistant strains 6.