From the Guidelines
The recommended treatment for urogenital Ureaplasma infection is doxycycline 100 mg orally twice daily for 7 days. This is based on the most recent guidelines from the European Association of Urology, as outlined in their 2024 guidelines 1. Alternative regimens include azithromycin 1.0–1.5 g p.o. as a single dose, which is also effective against Ureaplasma urealyticum 1.
Key Considerations
- The choice of antibiotic is crucial, as Ureaplasma species lack a cell wall, making them resistant to beta-lactam antibiotics like penicillins and cephalosporins.
- Macrolides, tetracyclines, or fluoroquinones are necessary for effective treatment, which is why doxycycline and azithromycin are recommended.
- It is essential to note that patients should abstain from sexual activity until therapy is completed and symptoms have resolved, and sexual partners should be treated simultaneously to prevent reinfection.
Treatment Outcomes
- Effective treatment can prevent complications such as pelvic inflammatory disease in women and epididymitis in men.
- Doxycycline 100 mg orally twice daily for 7 days is the preferred treatment, but azithromycin can be used as an alternative, especially in pregnant patients where doxycycline is contraindicated due to safety concerns.
- In cases of persistent infection or macrolide resistance, moxifloxacin 400 mg orally once daily for 7-14 days may be used, although this is not the first-line treatment for Ureaplasma urealyticum 1.
From the FDA Drug Label
Nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum: 100 mg, by mouth, twice a day for 7 days. The treatment for urogenital Ureaplasma (Ureaplasma urealyticum) infection is doxycycline 100 mg, by mouth, twice a day for 7 days 2.
- The recommended dosage is for the treatment of nongonococcal urethritis (NGU) caused by C. trachomatis or U. urealyticum.
- Doxycycline is the recommended antibiotic for this infection.
From the Research
Treatment Options for Urogenital Ureaplasma Infection
- Azithromycin has been shown to be effective in treating Ureaplasma urealyticum infections, with a single 1 g dose being as effective as a 7-day regimen of doxycycline 3.
- Doxycycline is also effective in treating Ureaplasma urealyticum infections, with a 7-day regimen being commonly used 3, 4, 5.
- Ciprofloxacin has been used to treat Ureaplasma urealyticum infections, but its efficacy is lower than that of azithromycin and doxycycline, with an eradication rate of 71.4% in one study 6.
- A comparative study of azithromycin and doxycycline found that both antibiotics had similar efficacy and tolerability in treating prostate infection caused by Ureaplasma urealyticum, with eradication rates of 78.1% and 74.2% respectively 7.
Antibiotic Susceptibility
- Ureaplasma urealyticum has been found to be highly resistant to clarithromycin, tetracycline, ciprofloxacin, and erythromycin, but sensitive to doxycycline 5.
- Mycoplasma hominis, which is often found in conjunction with Ureaplasma urealyticum, is resistant to tetracycline, clarithromycin, and erythromycin, but sensitive to doxycycline and ofloxacin 5.
Treatment Regimens
- A single 1 g dose of azithromycin has been used to treat Ureaplasma urealyticum infections 3.
- A 7-day regimen of doxycycline 100 mg twice daily has been used to treat Ureaplasma urealyticum infections 3, 4, 5.
- A 3-day therapy of 1 x 500 mg weekly for 3 weeks of azithromycin has been used to treat prostate infection caused by Ureaplasma urealyticum 7.