From the Guidelines
Doxycycline is the first-line antibiotic for treating Ureaplasma urealyticum infections, typically prescribed as 100 mg twice daily for 7 days. According to the European Association of Urology guidelines on urological infections, published in 2024 1, doxycycline is the recommended treatment for Ureaplasma urealyticum.
Alternative Treatment Options
- Azithromycin is an alternative option, usually given as a single 1-1.5 gram dose 1.
- The choice between doxycycline and azithromycin may depend on patient-specific factors, such as allergy history or potential side effects.
Importance of Completing Treatment
It's essential to complete the full course of antibiotics even if symptoms improve before finishing treatment, to ensure the infection is fully cleared and reduce the risk of antibiotic resistance.
Considerations for Treatment
- Sexual partners should also be treated simultaneously to prevent reinfection.
- Ureaplasma is effectively treated with these antibiotics because they target the bacteria's protein synthesis or DNA replication mechanisms.
- Some strains have developed resistance to certain antibiotics, so if symptoms persist after treatment, follow-up testing and potentially a different antibiotic may be needed, such as moxifloxacin 1.
From the FDA Drug Label
Ureaplasma urealyticum The following in vitro data are available, but their clinical significance is unknown At least 90% of the following bacteria exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the azithromycin susceptible breakpoint of ≤ 4mcg/mL. However, safety and effectiveness of azithromycin in treating clinical infections due to these bacteria have not been established in adequate and well-controlled trials “Other” bacteria Ureaplasma urealyticum Other Microorganisms Rickettsiae Chlamydia psittaci Chlamydia trachomatis Mycoplasma pneumoniae Ureaplasma urealyticum Borrelia recurrentis Treponema pallidum Treponema pertenue Clostridium species Fusobacterium fusiforme Actinomyces species Bacillus anthracis Propionibacterium acnes Entamoeba species Balantidium coli Plasmodium falciparum The antibiotic that may be used for Ureaplasma is:
- Azithromycin 2
- Doxycycline 3 Note that the effectiveness of these antibiotics in treating Ureaplasma infections has not been established in adequate and well-controlled trials.
From the Research
Antibiotic Treatment for Ureaplasma
- The efficacy of various antibiotics in treating Ureaplasma urealyticum has been studied in several research papers 4, 5, 6, 7, 8.
- Azithromycin and doxycycline are two commonly used antibiotics for the treatment of Ureaplasma urealyticum infections 4, 7, 8.
- A study published in 2001 found that azithromycin was more effective than doxycycline in eradicating Ureaplasma urealyticum in patients with symptoms lasting for 3 weeks or longer 4.
- Another study published in 2011 found that moxifloxacin was the most active agent in vitro against Ureaplasma urealyticum, followed closely by levofloxacin 5.
- A systematic review and meta-analysis published in 2023 found that azithromycin has a comparable therapeutic effect to doxycycline in treating Ureaplasma urealyticum 7.
- A study published in 2006 found that azithromycin and doxycycline had similar eradication and clinical cure rates in the treatment of prostate infection caused by Ureaplasma urealyticum 8.
Antibiotic Resistance
- Antibiotic resistance is a concern in the treatment of Ureaplasma urealyticum infections 6.
- A study published in 2017 found that low antibiotic resistance was found in a population of college-aged women with a first-time UTI, but two Ureaplasma parvum isolates were resistant to levofloxacin and tetracycline 6.
- The genetic mechanisms of resistance were determined, and the study found that the tetM gene was present in the tetracycline-resistant isolate and an S83W mutation within the parC gene of the quinolone-resistant isolate 6.
Treatment Options
- Azithromycin and doxycycline are commonly used treatment options for Ureaplasma urealyticum infections 4, 7, 8.
- Moxifloxacin and levofloxacin may also be effective treatment options based on in vitro studies 5.
- The choice of antibiotic and treatment duration may depend on the severity and duration of symptoms, as well as the presence of antibiotic resistance 4, 6, 7, 8.