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Volume 26, Number 8—August 2020
Dispatch

Doxycycline and Sitafloxacin Combination Therapy for Treating Highly Resistant Mycoplasma genitalium

Duygu DurukanComments to Author , Michelle Doyle, Gerald Murray, Kaveesha Bodiyabadu, Lenka Vodstrcil, Eric P.F. Chow, Jorgen S. Jensen, Christopher K. Fairley, Ivette Aguirre, and Catriona S. Bradshaw
Author affiliations: Alfred Health, Carlton, Victoria, Australia (D. Durukan, M. Doyle, L. Vodstrcil, E.P.F. Chow, C.K. Fairley, I. Aguirre, C.S. Bradshaw); Monash University, Clayton, Victoria, Australia (D. Durukan, L. Vodstrcil, E.P.F. Chow, C.K. Fairley, C.S. Bradshaw); Royal Children’s Hospital, Parkville, Victoria, Australia (G. Murray, K. Bodiyabadu); The Royal Women’s Hospital, Parkville (G. Murray, K. Bodiyabadu); Statens Serum Institut, Copenhagen, Denmark (J.S. Jensen)

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Table 1

Antimicrobial regimens and test of cure data for patients treated for Mycoplasma genitalium with doxycycline and sitafloxacin combination therapy, Melbourne Sexual Health Centre, Carleton, Victoria, Australia*

Case no. Baseline test First-line therapy, sequential; d
TOC Second-line therapy, sequential; d
TOC Third-line therapy, combination; d
TOC
Doxy† Moxi Doxy† Pris Doxy† Combination‡
+ 7 7 + 7 10 + 21 7 Cured
2 + 7 7 + 7 10 + 28 7 Cured
3 + 7 7 + 7 10 + 21 7 Cured
+ None 10¶ + 7 10 + None 7 Cured
5 + 7 7 + 7 10 + None 7 Cured
+ None 30¶ + 21 10 + 14 7 Cured
7 + 7 7 + None 10 + 7 7 Cured
8 + 7 7 + None 10 + 7 7 Cured
9 + 7 7 + 7 10 + 7 7 Failed
10§ + 7 + None 10 + 3 7 Cured
11§ + None 14# + None** None None 5 7 Cured
12 + 7 7 + 10†† 10 + 3 7 Cured

*Doxy, doxycycline; Moxi, moxifloxacin; Pris, pristinamycin; TOC, test of cure; +, macrolide-resistant M. genitalium detected.
†Doxycycline 100 mg 2 times/day commonly was given first as monotherapy in first, second, and third drug regimens; duration is specified for each case.
‡Sitafloxacin 100 mg 2 times/day and doxycycline 100 mg 2 times/day were given concurrently for 7 days.
§Patients who had prior failed antimicrobial therapy for M. genitalium infection before coming to Melbourne Sexual Health Centre (MSHC). Case no. 1 received 1 g azithromycin before coming to MSHC and this regimen failed. Case no. 4 received moxifloxacin 400 mg/d for 10 days before coming to MSHC and this regimen failed. Case no. 6 received 3 1-g doses of azithromycin given on separate occasions and this regimen failed, then received 2 courses of doxycycline 100 mg 2 times/day for 14 d each which also failed; then received a 30-day course of moxifloxacin 400 mg/d which also failed, before coming to MSHC. Case no. 10 received doxycycline 100 mg 2 times/day for 7 d then 1 g azithromycin which failed; then received doxycycline 100 mg 2 times/day for 7 d which failed, after which the patient received moxifloxacin 400 mg/d for 7 d, which also failed before coming to MSHC. Case no. 11 received doxycycline and azithromycin at unspecified doses or duration before coming to MSHC.
¶Moxifloxacin-containing regimen given to a patient in the community before they came to MSHC. This regimen often varied from firstline therapy given at MSHC.
#Moxifloxacin 400 mg/d × 14 d was given as a first regimen to this patient because of diagnosed pelvic inflammatory disease.
**Patient was diagnosed with possible M. genitalium–related pelvic inflammatory disease and did not receive a pristinamycin–containing regimen (14).
††Patient was given 1 g pristinamycin 3 times/day in combination with doxycycline 100 mg 2 times/day rather than 1 g 4 times/day because both regimens have shown equivalent efficacy at our service (10).

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References
  1. Bradshaw  CS, Jensen  JS, Waites  KB. New horizons in Mycoplasma genitalium treatment. J Infect Dis. 2017;216(suppl_2):S412–S9.
  2. Hamasuna  R, Le  PT, Kutsuna  S, Furubayashi  K, Matsumoto  M, Ohmagari  N, et al. Mutations in ParC and GyrA of moxifloxacin-resistant and susceptible Mycoplasma genitalium strains. PLoS One. 2018;13:e0198355. DOIPubMed
  3. Braam  JF, van Dommelen  L, Henquet  CJM, van de Bovenkamp  JHB, Kusters  JG. Multidrug-resistant Mycoplasma genitalium infections in Europe. Eur J Clin Microbiol Infect Dis. 2017;36:15657. DOIPubMed
  4. Xiao  L, Waites  KB, Van Der Pol  B, Aaron  KJ, Hook  EW III, Geisler  WM. Mycoplasma genitalium infections with macrolide and fluoroquinolone resistance-associated mutations in heterosexual African American couples in Alabama. Sex Transm Dis. 2019;46:1824. DOIPubMed
  5. Murray  GL, Bodiyabadu  K, Danielewski  J, Garland  SM, Machalek  DA, Fairley  CK, et al. Moxifloxacin and sitafloxacin treatment failure in Mycoplasma genitalium infection: sssociation with parC mutation G248T (S83I) and concurrent gyrA mutations. J Infect Dis. 2020;221:101724.PubMed
  6. Machalek  D, Tao  Y, Shilling  H, Jensen  J, Unemo  M, Murray  G, et al. P601 Macrolide and fluoroquinolone resistance-associated mutations in Mycoplasma genitalium: a systematic review and meta-analysis. Sex Transm Infect. 2019;95(Suppl 1):A266.
  7. Durukan  D, Read  TRH, Murray  G, Doyle  M, Chow  EPF, Vodstrcil  LA, et al. Resistance-guided antimicrobial therapy using doxycycline-moxifloxacin and doxycycline-2.5g azithromycin for the treatment of Mycoplasma genitalium infection: efficacy and tolerability. Clin Infect Dis. 2019;ciz1031; Epub ahead of print. DOIPubMed
  8. Soni  S, Horner  P, Rayment  M, Pinto-Sander  N, Naous  N, Parkhouse  A, et al. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018). Int J STD AIDS. 2019;30:93850. DOIPubMed
  9. Australia  SHA. Australian STI management guidelines for use in primary care. Sydney, Australia: The Alliance; 2018 [cited 2019 Dec 3]. http://www.sti.guidelines.org.au
  10. Read  TRH, Jensen  JS, Fairley  CK, Grant  M, Danielewski  JA, Su  J, et al. Use of pristinamycin for macrolide-resistant Mycoplasma genitalium infection. Emerg Infect Dis. 2018;24:32835. DOIPubMed
  11. Takahashi  S, Hamasuna  R, Yasuda  M, Ito  S, Ito  K, Kawai  S, et al. Clinical efficacy of sitafloxacin 100 mg twice daily for 7 days for patients with non-gonococcal urethritis. J Infect Chemother. 2013;19:9415. DOIPubMed
  12. Read  TRH, Fairley  CK, Murray  GL, Jensen  JS, Danielewski  J, Worthington  K, et al. Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation. Clin Infect Dis. 2019;68:55460. DOIPubMed

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Page created: June 08, 2020
Page updated: July 18, 2020
Page reviewed: July 18, 2020
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