Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Read, Tim R H, Fairley, Christopher K, Murray, Gerald L, Jensen, Jorgen S, Danielewski, Jennifer, Worthington, Karen, Doyle, Michelle, Mokany, Elisa, Tan, Litty, Chow, Eric P F, Garland, Suzanne M, Bradshaw, Catriona S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355821/
https://www.ncbi.nlm.nih.gov/pubmed/29873691
http://dx.doi.org/10.1093/cid/ciy477
_version_ 1783391396105814016
author Read, Tim R H
Fairley, Christopher K
Murray, Gerald L
Jensen, Jorgen S
Danielewski, Jennifer
Worthington, Karen
Doyle, Michelle
Mokany, Elisa
Tan, Litty
Chow, Eric P F
Garland, Suzanne M
Bradshaw, Catriona S
author_facet Read, Tim R H
Fairley, Christopher K
Murray, Gerald L
Jensen, Jorgen S
Danielewski, Jennifer
Worthington, Karen
Doyle, Michelle
Mokany, Elisa
Tan, Litty
Chow, Eric P F
Garland, Suzanne M
Bradshaw, Catriona S
author_sort Read, Tim R H
collection PubMed
description 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 log(10) (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.
format Online
Article
Text
id pubmed-6355821
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-63558212019-02-08 Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation Read, Tim R H Fairley, Christopher K Murray, Gerald L Jensen, Jorgen S Danielewski, Jennifer Worthington, Karen Doyle, Michelle Mokany, Elisa Tan, Litty Chow, Eric P F Garland, Suzanne M Bradshaw, Catriona S Clin Infect Dis Articles and Commentaries 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 log(10) (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. Oxford University Press 2019-02-15 2018-06-05 /pmc/articles/PMC6355821/ /pubmed/29873691 http://dx.doi.org/10.1093/cid/ciy477 Text en © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Articles and Commentaries
Read, Tim R H
Fairley, Christopher K
Murray, Gerald L
Jensen, Jorgen 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
title Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation
title_full Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation
title_fullStr Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation
title_full_unstemmed Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation
title_short Outcomes of Resistance-guided Sequential Treatment of Mycoplasma genitalium Infections: A Prospective Evaluation
title_sort outcomes of resistance-guided sequential treatment of mycoplasma genitalium infections: a prospective evaluation
topic Articles and Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355821/
https://www.ncbi.nlm.nih.gov/pubmed/29873691
http://dx.doi.org/10.1093/cid/ciy477
work_keys_str_mv AT readtimrh outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT fairleychristopherk outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT murraygeraldl outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT jensenjorgens outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT danielewskijennifer outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT worthingtonkaren outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT doylemichelle outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT mokanyelisa outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT tanlitty outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT chowericpf outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT garlandsuzannem outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation
AT bradshawcatrionas outcomesofresistanceguidedsequentialtreatmentofmycoplasmagenitaliuminfectionsaprospectiveevaluation