title: Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections.
abstract: Mycoplasma genitalium has been causally linked with nongonococcal urethritis in men and cervicitis, pelvic inflammatory disease, preterm birth, spontaneous abortion, and infertility in women, yet treatment has proven challenging. To inform treatment recommendations, we reviewed English-language studies describing antimicrobial susceptibility, resistance-associated mutations, and clinical efficacy of antibiotic therapy, identified via a systematic search of PubMed supplemented by expert referral. Minimum inhibitory concentrations (MICs) from some contemporary isolates exhibited high-level susceptibility to most macrolides and quinolones, and moderate susceptibility to most tetracyclines, whereas other contemporary isolates had high MICs to the same antibiotics. Randomized trials demonstrated poor efficacy of doxycycline and better, but declining, efficacy of single-dose azithromycin therapy. Treatment failures after extended doses of azithromycin similarly increased, and circulating macrolide resistance was present in high levels in several areas. Moxifloxacin remains the most effective therapy, but treatment failures and quinolone resistance are emerging. Surveillance of M. genitalium prevalence and antimicrobial resistance patterns is urgently needed.
authors.affiliation: Department of Epidemiology Department of Center for AIDS and STD, University of Washington, Seattle.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Manhart
authors.affiliation: Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Jørgen Skov
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Melbourne Sexual Health Center and Monash University, Australia.
authors.forename: Catriona S
authors.initials: CS
authors.lastname: Bradshaw
authors.affiliation: Department of Medicine Department of Center for AIDS and STD, University of Washington, Seattle.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
authors.affiliation: Division of Infectious Diseases, Louisiana State University, New Orleans.
authors.forename: David H
authors.initials: DH
authors.lastname: Martin
mesh_terms: D000022:Abortion, Spontaneous / Q000382:microbiology / Q000517:prevention & control; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D002986:Clinical Trials as Topic; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005260:Female; D006801:Humans; D018942:Macrolides / Q000494:pharmacology / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D009175:Mycoplasma Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D045704:Mycoplasma genitalium / Q000187:drug effects*; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy / Q000382:microbiology; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology; D014526:Urethritis / Q000188:drug therapy / Q000382:microbiology; D002575:Uterine Cervicitis / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides
keywords: Mycoplasma genitalium; antimicrobial; drug resistance; sexually transmitted diseases; therapeutics