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Volume 26, Number 8—August 2020

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)

Main Article

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