Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation

Timothy Richard Read, Christopher K Fairley, Gerald Laurence Murray, Jørgen S. Jensen, Jennifer Danielewski, Karen Worthington, Michelle Doyle, Elisa Mokany, litty tan, Eric P.F. Chow, Suzanne M Garland, Catriona S. Bradshaw

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. Methods: In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. Results: Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4% [95% confidence interval {CI}, 62.2%-74.2%]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8% [95% CI, 87.2%-98.6%]) and in 154 of 167 MRM-positive infections (92.2% [95% CI, 87.1%-95.8%]). Selection of macrolide resistance occurred in only 2 of 76 (2.6% [95% CI, .3%-9.2%]) macrolide-susceptible infections. Conclusions: In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance.

Original languageEnglish
Pages (from-to)554-560
Number of pages7
JournalClinical Infectious Diseases
Volume68
Issue number4
DOIs
Publication statusPublished - 1 Feb 2019

Cite this

Read, Timothy Richard ; Fairley, Christopher K ; Murray, Gerald Laurence ; Jensen, Jørgen S. ; Danielewski, Jennifer ; Worthington, Karen ; Doyle, Michelle ; Mokany, Elisa ; tan, litty ; Chow, Eric P.F. ; Garland, Suzanne M ; Bradshaw, Catriona S. / Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections : A Prospective Evaluation. In: Clinical Infectious Diseases. 2019 ; Vol. 68, No. 4. pp. 554-560.
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title = "Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation",
abstract = "Background: Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. Methods: In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. Results: Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4{\%} [95{\%} confidence interval {CI}, 62.2{\%}-74.2{\%}]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8{\%} [95{\%} CI, 87.2{\%}-98.6{\%}]) and in 154 of 167 MRM-positive infections (92.2{\%} [95{\%} CI, 87.1{\%}-95.8{\%}]). Selection of macrolide resistance occurred in only 2 of 76 (2.6{\%} [95{\%} CI, .3{\%}-9.2{\%}]) macrolide-susceptible infections. Conclusions: In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92{\%} of infections, with infrequent selection of macrolide resistance.",
author = "Read, {Timothy Richard} and Fairley, {Christopher K} and Murray, {Gerald Laurence} and Jensen, {J{\o}rgen S.} and Jennifer Danielewski and Karen Worthington and Michelle Doyle and Elisa Mokany and litty tan and Chow, {Eric P.F.} and Garland, {Suzanne M} and Bradshaw, {Catriona S.}",
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Read, TR, Fairley, CK, Murray, GL, Jensen, JS, Danielewski, J, Worthington, K, Doyle, M, Mokany, E, tan, L, Chow, EPF, Garland, SM & Bradshaw, CS 2019, 'Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation' Clinical Infectious Diseases, vol. 68, no. 4, pp. 554-560. https://doi.org/10.1093/cid/ciy477

Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections : A Prospective Evaluation. / Read, Timothy Richard; Fairley, Christopher K; Murray, Gerald Laurence; Jensen, Jørgen S.; Danielewski, Jennifer; Worthington, Karen; Doyle, Michelle ; Mokany, Elisa; tan, litty; Chow, Eric P.F.; Garland, Suzanne M; Bradshaw, Catriona S.

In: Clinical Infectious Diseases, Vol. 68, No. 4, 01.02.2019, p. 554-560.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections

T2 - A Prospective Evaluation

AU - Read, Timothy Richard

AU - Fairley, Christopher K

AU - Murray, Gerald Laurence

AU - Jensen, Jørgen S.

AU - Danielewski, Jennifer

AU - Worthington, Karen

AU - Doyle, Michelle

AU - Mokany, Elisa

AU - tan, litty

AU - Chow, Eric P.F.

AU - Garland, Suzanne M

AU - Bradshaw, Catriona S.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. Methods: In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. Results: Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4% [95% confidence interval {CI}, 62.2%-74.2%]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8% [95% CI, 87.2%-98.6%]) and in 154 of 167 MRM-positive infections (92.2% [95% CI, 87.1%-95.8%]). Selection of macrolide resistance occurred in only 2 of 76 (2.6% [95% CI, .3%-9.2%]) macrolide-susceptible infections. Conclusions: In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance.

AB - Background: Rising macrolide and quinolone resistance in Mycoplasma genitalium necessitate new treatment approaches. We evaluated outcomes of sequential antimicrobial therapy for M. genitalium guided by a macrolide-resistance assay. Methods: In mid-2016, Melbourne Sexual Health Centre switched from azithromycin to doxycycline (100 mg twice daily for 7 days) for nongonococcal urethritis, cervicitis, and proctitis. Cases were tested for M. genitalium and macrolide-resistance mutations (MRMs) by polymerase chain reaction. Directly after doxycycline, MRM-negative infections received 2.5 g azithromycin (1 g, then 500 mg daily for 3 days), and MRM-positive infections received sitafloxacin (100 mg twice daily for 7 days). Assessment of test of cure and reinfection risk occurred 14-90 days after the second antibiotic. Results: Of 244 evaluable M. genitalium infections (52 women, 68 heterosexual men, 124 men who have sex with men) diagnosed from 20 June 2016 to 15 May 2017, MRMs were detected in 167 (68.4% [95% confidence interval {CI}, 62.2%-74.2%]). Treatment with doxycycline decreased bacterial load by a mean 2.60 log10 (n = 56; P < .0001). Microbiologic cure occurred in 73 of 77 MRM-negative infections (94.8% [95% CI, 87.2%-98.6%]) and in 154 of 167 MRM-positive infections (92.2% [95% CI, 87.1%-95.8%]). Selection of macrolide resistance occurred in only 2 of 76 (2.6% [95% CI, .3%-9.2%]) macrolide-susceptible infections. Conclusions: In the context of high levels of antimicrobial resistance, switching from azithromycin to doxycycline for presumptive treatment of M. genitalium, followed by resistance-guided therapy, cured ≥92% of infections, with infrequent selection of macrolide resistance.

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U2 - 10.1093/cid/ciy477

DO - 10.1093/cid/ciy477

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VL - 68

SP - 554

EP - 560

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 4

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