"Emerging sex disease MG 'could become next superbug'," reports BBC News about a sexually transmitted bacterial infection (STI) called mycoplasma genitalium (MG), which is becoming increasingly resistant to antibiotics. Meanwhile the Mail Online described it as the "'stealth' STI that makes women infertile" because it can trigger pelvic inflammatory disease, which can lead to infertility in some cases. The British Association of Sexual Health and HIV (BASHH) released draft guidance today because of concerns that if MG is missed and not properly treated, it can develop resistance to antibiotics and become increasingly difficult to treat. Data suggests that some widely used antibiotics used to treat MG are already not working. Antibiotic resistance is when certain strains of bacteria mutate so antibiotics are no longer able to kill them. The UK media has widely reported that an estimated 3,000 women a year in the UK could become infertile if MG becomes resistant to all antibiotics. We are unable to comment on the accuracy of this estimate as BASHH has not published the data that the estimate is presumably based on. All mycoplasmas lack a cell wall and, therefore, all are inherently resistant to beta-lactam antibiotics (e.g., penicillin). Clinicians treat the disease with macrolide, tetracycline, or fluoroquinolone classes of antibiotics, taking age of the patient and local antibiotic resistance patterns into consideration: Clinicians should not prescribe fluoroquinolones and tetracyclines for young children under normal circumstances. Macrolides are generally considered the treatment of choice. However, clinicians should practice prudent use of macrolide drugs due to the emergence of macrolide-resistant strains of since 2000. This issue is especially troubling in Asia, where resistance rates have been as high as 90%. The United States and Europe have also reported macrolide resistance. Current data suggest that the prevalence of macrolide resistance in is probably rising in the United States.
Treatment studies using azithromycin 1 g single dose and azithromycin 500 mg on day 1 then 250 mg daily for 4 days (5-day regimen) to determine rates of treatment failure and resistance in both regimens. Studies were eligible if they: used azithromycin 1 g or 5 days, assessed patients for macrolide resistant genetic mutations prior to treatment and patients who failed were again resistance genotyped. Random effects meta-analysis was used to estimate failure and resistance rates. Results Eight studies were identified totalling 435 patients of whom 82 (18.9%) had received the 5-day regimen. The random effects pooled rate of treatment failure and development of macrolide antimicrobial resistance mutations with azithromycin 1 g was 13.9% (95% CI 7.7% to 20.1%) and 12.0% (7.1% to 16.9%), respectively. Of individuals treated with the 5-day regimen, with no prior doxycycline treatment, fewer (3.7%; 95% CI 0.8% to 10.3%, p=0.012) failed treatment, all of whom developed resistance (p=0.027). If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s Rights Link service. You will be able to get a quick price and instant permission to reuse the content in many different ways. Oral erythromycin or one of the newer macrolides such as azithromycin or clarithromycin have long been the DOC for mycoplasmal respiratory tract infections. Clindamycin is effective in vitro, but limited reports suggest it may not be active in vivo and thus is not considered a first-line treatment. Fluoroquinolones such as levofloxacin or moxifloxacin exhibit bactericidal antimycoplasmal activity but are generally less potent in vitro than macrolides against species are slow-growing organisms that have the capacity to reside intracellularly; thus, respiratory tract infections are expected to respond better to longer treatment courses than might be offered for other types of infections. Although physicians typically prescribe most treatment regimens (ie, both oral and parenteral) for 7-10 days, a 14- to 21-day course of oral therapy with most agents is also appropriate. A 5-day course of oral azithromycin is approved for the treatment of community-acquired pneumonia. Clinical data indicate that this duration of treatment is of comparable efficacy to a 10-day course of erythromycin. Other drugs, including fluoroquinolones, have been approved for the treatment of mycoplasmal respiratory infections with shorter courses because of their favorable pharmacokinetics and tolerability. infections, other measures (eg, cough suppressants, antipyretics, analgesics) should be administered as needed to relieve headaches and other systemic symptoms.
Mycoplasma genitalium has been well described as a pathogen in men with acute and chronic nongonococcal urethritis NGU and has been associated with cervicitis in women. Since culturing the organism is difficult, limited information has been available regarding its antimicrobial drug susceptibility. Mycoplasma species are the smallest free-living organisms. the newer macrolides such as azithromycin or clarithromycin have long been the.