Volume 26, Number 8—August 2020
Dispatch
Doxycycline and Sitafloxacin Combination Therapy for Treating Highly Resistant Mycoplasma genitalium
, Michelle Doyle, Gerald Murray, Kaveesha Bodiyabadu, Lenka Vodstrcil, Eric P.F. Chow, Jorgen S. Jensen, Christopher K. Fairley, Ivette Aguirre, and Catriona S. Bradshaw
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‡ | |||||
| 1§ | + | 7 | 7 | + | 7 | 10 | + | 21 | 7 | Cured |
| 2 | + | 7 | 7 | + | 7 | 10 | + | 28 | 7 | Cured |
| 3 | + | 7 | 7 | + | 7 | 10 | + | 21 | 7 | Cured |
| 4§ | + | None | 10¶ | + | 7 | 10 | + | None | 7 | Cured |
| 5 | + | 7 | 7 | + | 7 | 10 | + | None | 7 | Cured |
| 6§ | + | 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 | 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).
References
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