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Persistence of Mycoplasma genitalium following azithromycin therapy.

Bradshaw CS, Chen MY, Fairley CK - PLoS ONE (2008)

Bottom Line: Moxifloxacin was effective in eradicating persistent infection in all cases not responding to azithromycin.Patients with persistent-M.genitalium were more likely to experience persistent symptoms (91%), compared to patients in whom M.genitalium was eradicated (17%), p<0.0001.Use of azithromycin 1 g in M.genitalium-infected patients was associated with unacceptable rates of persistent infection, which was eradicated with moxifloxacin.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. cbradshaw@mshc.org.au

ABSTRACT

Background: To determine clinical outcomes and cure rates for M.genitalium genital infection in men and women following azithromycin 1 g.

Methodology: Patients attending Melbourne Sexual Health Centre between March 2005 and November 2007 with urethritis/epididymitis, cervicitis/pelvic inflammatory disease and sexual contacts of M.genitalium were tested for M.genitalium by polymerase chain reaction (PCR). M.genitalium-infection was treated with 1 g of azithromycin and a test-of-cure (toc) was performed one month post-azithromycin. Response to azithromycin, and response to moxifloxacin (400 mg daily for 10 days) in individuals with persistent infection post-azithromycin, was determined.

Principal findings: Of 1538 males and 313 females tested, 161 males (11%) and 30 females (10%) were infected with M.genitalium. A toc was available on 131 (69%) infected individuals (median = 36 days [range 12-373]). Of 120 individuals prescribed azithromycin only pre-toc, M.genitalium was eradicated in 101 (84%, 95% confidence intervals [CI]: 77-90%) and persisted in 19 (16%, 95% CI: 10-23%). Eleven individuals with persistent infection (9%, 95% CI: 5-15%) had no risk of reinfection from untreated-partners, while eight (7%, 95% CI: 3-12%) may have been at risk of reinfection from doxycycline-treated or untreated-partners. Moxifloxacin was effective in eradicating persistent infection in all cases not responding to azithromycin. Patients with persistent-M.genitalium were more likely to experience persistent symptoms (91%), compared to patients in whom M.genitalium was eradicated (17%), p<0.0001.

Conclusion: Use of azithromycin 1 g in M.genitalium-infected patients was associated with unacceptable rates of persistent infection, which was eradicated with moxifloxacin. These findings highlight the importance of follow-up in M.genitalium-infected patients prescribed azithromycin, and the need to monitor for the development of resistance. Research to determine optimal first and second-line therapeutic agents for M.genitalium is needed.

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Related in: MedlinePlus

* = cases with no risk of reinfection from untreated sexual partner, d = days, C1 = case 1, C2 = case 2, (A1) = first occasion 1 g azithromycin administered, (A2) = second occasion 1 g azithromycin administered, (M1) = first occasion 400 mg daily of moxifloxacin for 10 days administered, (D1) = first occasion 100 mg bd doxycycline for 7 days administered, SP = sexual partner, no Rx = no treatment administered, toc1 = first test of cure for case, toc2 = second test of cure for case, + = positive, − = negative, NA =  not available, #sp not retreated with azithromycin after first occasion, ? = treatment advised but could not be verified.
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pone-0003618-g001: * = cases with no risk of reinfection from untreated sexual partner, d = days, C1 = case 1, C2 = case 2, (A1) = first occasion 1 g azithromycin administered, (A2) = second occasion 1 g azithromycin administered, (M1) = first occasion 400 mg daily of moxifloxacin for 10 days administered, (D1) = first occasion 100 mg bd doxycycline for 7 days administered, SP = sexual partner, no Rx = no treatment administered, toc1 = first test of cure for case, toc2 = second test of cure for case, + = positive, − = negative, NA =  not available, #sp not retreated with azithromycin after first occasion, ? = treatment advised but could not be verified.

Mentions: Of the 19 individuals with M.genitalium detected at toc1, 10 provided a second toc (toc2), Figure 1. Six patients with persistent M.genitalium-infection had no risk of reinfection from an untreated sexual partner; 5 had sexual partners who been treated concurrently with azithromycin on one or more occasions, and one had remained celibate. Notably, in three couples simultaneous administration of azithromycin to sexual partners on two consecutive occasions failed to eradicate M.genitalium, and it was only when both index and partner were concurrently treated with moxifloxacin did a third toc show that M.genitalium had been eradicated. Four patients with persistent infection post-azithromycin may have been at risk of reinfection from an untreated or doxycyline treated partner. Importantly, moxifloxacin eradicated persistent infection following azithromycin in all cases.


Persistence of Mycoplasma genitalium following azithromycin therapy.

Bradshaw CS, Chen MY, Fairley CK - PLoS ONE (2008)

* = cases with no risk of reinfection from untreated sexual partner, d = days, C1 = case 1, C2 = case 2, (A1) = first occasion 1 g azithromycin administered, (A2) = second occasion 1 g azithromycin administered, (M1) = first occasion 400 mg daily of moxifloxacin for 10 days administered, (D1) = first occasion 100 mg bd doxycycline for 7 days administered, SP = sexual partner, no Rx = no treatment administered, toc1 = first test of cure for case, toc2 = second test of cure for case, + = positive, − = negative, NA =  not available, #sp not retreated with azithromycin after first occasion, ? = treatment advised but could not be verified.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2572837&req=5

pone-0003618-g001: * = cases with no risk of reinfection from untreated sexual partner, d = days, C1 = case 1, C2 = case 2, (A1) = first occasion 1 g azithromycin administered, (A2) = second occasion 1 g azithromycin administered, (M1) = first occasion 400 mg daily of moxifloxacin for 10 days administered, (D1) = first occasion 100 mg bd doxycycline for 7 days administered, SP = sexual partner, no Rx = no treatment administered, toc1 = first test of cure for case, toc2 = second test of cure for case, + = positive, − = negative, NA =  not available, #sp not retreated with azithromycin after first occasion, ? = treatment advised but could not be verified.
Mentions: Of the 19 individuals with M.genitalium detected at toc1, 10 provided a second toc (toc2), Figure 1. Six patients with persistent M.genitalium-infection had no risk of reinfection from an untreated sexual partner; 5 had sexual partners who been treated concurrently with azithromycin on one or more occasions, and one had remained celibate. Notably, in three couples simultaneous administration of azithromycin to sexual partners on two consecutive occasions failed to eradicate M.genitalium, and it was only when both index and partner were concurrently treated with moxifloxacin did a third toc show that M.genitalium had been eradicated. Four patients with persistent infection post-azithromycin may have been at risk of reinfection from an untreated or doxycyline treated partner. Importantly, moxifloxacin eradicated persistent infection following azithromycin in all cases.

Bottom Line: Moxifloxacin was effective in eradicating persistent infection in all cases not responding to azithromycin.Patients with persistent-M.genitalium were more likely to experience persistent symptoms (91%), compared to patients in whom M.genitalium was eradicated (17%), p<0.0001.Use of azithromycin 1 g in M.genitalium-infected patients was associated with unacceptable rates of persistent infection, which was eradicated with moxifloxacin.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. cbradshaw@mshc.org.au

ABSTRACT

Background: To determine clinical outcomes and cure rates for M.genitalium genital infection in men and women following azithromycin 1 g.

Methodology: Patients attending Melbourne Sexual Health Centre between March 2005 and November 2007 with urethritis/epididymitis, cervicitis/pelvic inflammatory disease and sexual contacts of M.genitalium were tested for M.genitalium by polymerase chain reaction (PCR). M.genitalium-infection was treated with 1 g of azithromycin and a test-of-cure (toc) was performed one month post-azithromycin. Response to azithromycin, and response to moxifloxacin (400 mg daily for 10 days) in individuals with persistent infection post-azithromycin, was determined.

Principal findings: Of 1538 males and 313 females tested, 161 males (11%) and 30 females (10%) were infected with M.genitalium. A toc was available on 131 (69%) infected individuals (median = 36 days [range 12-373]). Of 120 individuals prescribed azithromycin only pre-toc, M.genitalium was eradicated in 101 (84%, 95% confidence intervals [CI]: 77-90%) and persisted in 19 (16%, 95% CI: 10-23%). Eleven individuals with persistent infection (9%, 95% CI: 5-15%) had no risk of reinfection from untreated-partners, while eight (7%, 95% CI: 3-12%) may have been at risk of reinfection from doxycycline-treated or untreated-partners. Moxifloxacin was effective in eradicating persistent infection in all cases not responding to azithromycin. Patients with persistent-M.genitalium were more likely to experience persistent symptoms (91%), compared to patients in whom M.genitalium was eradicated (17%), p<0.0001.

Conclusion: Use of azithromycin 1 g in M.genitalium-infected patients was associated with unacceptable rates of persistent infection, which was eradicated with moxifloxacin. These findings highlight the importance of follow-up in M.genitalium-infected patients prescribed azithromycin, and the need to monitor for the development of resistance. Research to determine optimal first and second-line therapeutic agents for M.genitalium is needed.

Show MeSH
Related in: MedlinePlus