Volume 26, Number 8—August 2020
Doxycycline and Sitafloxacin Combination Therapy for Treating Highly Resistant Mycoplasma genitalium
|Case no.||Baseline test||First-line therapy, sequential; d
||TOC||Second-line therapy, sequential; d
||TOC||Third-line therapy, combination; d
*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).
- Bradshaw CS, Jensen JS, Waites KB. New horizons in Mycoplasma genitalium treatment. J Infect Dis. 2017;216(suppl_2):S412–S9.
- 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:
- 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;36:1565–7.
- 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;46:18–24.
- 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;221:1017–24.
- 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.
- 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.
- 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;30:938–50.
- 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
- 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;24:328–35.
- 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;19:941–5.
- 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;68:554–60.