Mycoplasma UTI Treatment
Mycoplasma species do not cause typical urinary tract infections and are not addressed in standard UTI treatment guidelines. The evidence provided focuses on Mycoplasma genitalium causing urethritis (a sexually transmitted infection), not UTI, and standard UTI pathogens like E. coli, Klebsiella, and Proteus 1.
Critical Distinction: Urethritis vs. UTI
- Mycoplasma genitalium causes urethritis, which is sexually transmitted and presents with urethral discharge, dysuria, and urethral pruritus 1
- True UTIs involve bladder (cystitis) or kidney (pyelonephritis) infection with typical uropathogens 1
- The microbial spectrum for UTIs includes E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1
If This Is Actually Urethritis (Mycoplasma genitalium)
For confirmed M. genitalium urethritis, azithromycin 1.5g over 5 days (500mg day 1, then 250mg daily for 4 days) is recommended, though efficacy has declined significantly. 2, 3
Treatment Algorithm for M. genitalium Urethritis:
First-line: Azithromycin 1.5g extended regimen (500mg on day 1, then 250mg daily for 4 days) 2
Avoid doxycycline: Only 43% eradication rate (48% women, 38% men) 2
Second-line (treatment failure): Moxifloxacin 400mg daily for 7 days achieves 100% cure after azithromycin failure 5
Major Pitfall:
- Macrolide resistance is now present in up to 52% of M. genitalium cases 3
- Single-dose azithromycin 1g causes resistance mutations in 100% of treatment failures 2
- Extended azithromycin does not prevent resistance development better than single-dose 3
If This Is Actually a UTI
For uncomplicated UTI, use first-line therapy: nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin for 7 days maximum 1
For complicated UTI with systemic symptoms, use IV third-generation cephalosporin, or amoxicillin plus aminoglycoside, or second-generation cephalosporin plus aminoglycoside for 7-14 days 1
Standard UTI Treatment:
- Uncomplicated cystitis: Nitrofurantoin, TMP-SMX, or fosfomycin based on local antibiogram 1
- Complicated UTI: IV combination therapy initially, then oral based on culture results 1
- Duration: 7 days for uncomplicated, 7-14 days for complicated (14 days for men when prostatitis cannot be excluded) 1
Key Point:
Obtain urine culture before treatment in all cases to confirm the actual pathogen 1. If Mycoplasma is truly isolated from urine (extremely rare), this represents an unusual clinical scenario requiring infectious disease consultation, as Mycoplasma is not a recognized uropathogen in standard guidelines 1.