Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton Melbourne Sexual Health Centre, Alfred Hospital Central Clinical School, Monash University, Melbourne, Victoria, Australia.
Clin Infect Dis. 2015 Nov 1;61(9):1389-99. doi: 10.1093/cid/civ644. Epub 2015 Aug 3.
Mycoplasma genitalium (MG) is associated with nongonococcal urethritis in men and cervicitis in women. Current guidelines recommend treatment with 1 gram of azithromycin; however, treatment failure has increasingly been reported. This meta-analysis estimates treatment efficacy following treatment with 1 gram of azithromycin.
Electronic databases were searched for articles published to the end of February 2015 using the following search terms: (Mycoplasma genitalium) AND (azithromycin OR zithromax OR [treatment efficacy]). Studies were included if they were English language, had participants aged ≥12 years diagnosed with urogenital MG, and had microbial cure measured within 12 months of treatment. Treatment efficacy was measured as microbial cure at last follow-up after treatment.
A total of 21 studies, including 1490 participants, fulfilled the inclusion criteria. Most studies were observational, with only 5 controlled trials identified. The random-effects pooled microbial cure was 77.2% (95% confidence interval [CI], 71.1%-83.4%; I(2) = 80.8%, P < .01). For the 12 studies conducted prior to 2009, pooled microbial cure was 85.3% (CI, 82.3%-88.3%; I(2) = 19.7%, P = .25); for the 9 studies conducted since the beginning of 2009, pooled microbial cure was 67.0% (CI, 57.0%-76.9%; I(2) = 80.9%, P < .01).
The efficacy of a single dose of 1 gram of azithromycin for the treatment of urogenital MG has decreased to approach 60%. Even though most of the available evidence is based on observational studies that have considerable variability in sample size and timing of microbial cure, this low efficacy is of considerable concern. It is vital that new treatment options for MG are investigated.
生殖支原体（MG）与男性非淋菌性尿道炎和女性宫颈炎有关。目前的指南建议使用 1 克阿奇霉素治疗；然而，治疗失败的情况越来越多。本荟萃分析估计了使用 1 克阿奇霉素治疗后的治疗效果。
使用以下搜索词在电子数据库中搜索截至 2015 年 2 月底发表的文章：（生殖支原体）和（阿奇霉素或红霉素或[治疗效果]）。如果研究为英文，参与者年龄≥12 岁，被诊断为泌尿生殖系 MG，并且在治疗后 12 个月内测量微生物治愈率，则将其纳入研究。治疗效果定义为治疗后最后一次随访时的微生物治愈率。
共有 21 项研究，包括 1490 名参与者，符合纳入标准。大多数研究为观察性研究，仅确定了 5 项对照试验。随机效应合并微生物治愈率为 77.2%（95%置信区间[CI]，71.1%-83.4%；I(2)=80.8%，P<.01）。对于 2009 年之前进行的 12 项研究，合并微生物治愈率为 85.3%（CI，82.3%-88.3%；I(2)=19.7%，P=0.25）；对于 2009 年以来进行的 9 项研究，合并微生物治愈率为 67.0%（CI，57.0%-76.9%；I(2)=80.9%，P<.01）。
单次使用 1 克阿奇霉素治疗泌尿生殖系 MG 的疗效已降至接近 60%。尽管大多数现有证据基于观察性研究，这些研究在样本量和微生物治愈率的时间上存在很大差异，但这种低疗效令人严重关切。迫切需要研究新的 MG 治疗选择。
