Central Clinical School, Monash University, and
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Clin Infect Dis. 2017 Feb 1;64(3):250-256. doi: 10.1093/cid/ciw719. Epub 2016 Oct 24.
We evaluated the impact of extended azithromycin (1.5g over 5 days) on selection of macrolide resistance and microbiological cure in men with Mycoplasma genitalium urethritis during 2013-2015 and compared this to cases treated with azithromycin 1g in 2012-2013.
Microbiological cure was determined for men with M. genitalium urethritis treated with azithromycin 1.5g using quantitative polymerase chain reaction specific for M. genitalium DNA on samples 14-100 days post-treatment. Pre- and post-treatment macrolide resistance mutations were detected by sequencing the 23 S gene.
There was no difference in proportions with microbiological cure between azithromycin 1.5g and 1g: 62/106 (58%; 95% confidence interval [CI], 49%, 68%) and 56/107 (52%; 95%CI 42-62%), P = .34, respectively. Also, there was no difference in the proportion of wild-type 23 S rRNA (presumed macrolide sensitive) infections cured after 1.5g and azithromycin 1g: 28/34 (82%; 95%CI 65-92%) and 49/60 (82%; 95%CI 70-90%), P=1.0, respectively. There was no difference between 1.5g and 1g in the proportions of wild-type infections with post-treatment resistance mutations: 4/34 (12%; 95%CI 3-27%) and 11/60 (18%; 95%CI 10-30%), respectively, P = .40. Pre-treatment resistance was present in 51/98 (52%; 95%CI 42-62%) cases in 2013-2015 compared to 47/107 (44%; 95%CI 34-54%) in 2012-2013, P = .25.
Extended azithromycin 1.5g was no more effective than a single 1g dose at achieving cure of M. genitalium urethritis and importantly did not reduce the selection of macrolide resistance. Nonmacrolide and new approaches for the treatment of M. genitalium urethritis are required.
我们评估了延长阿奇霉素（5 天内 1.5g）治疗对 2013-2015 年男性解脲支原体尿道炎患者选择大环内酯类耐药性和微生物学治愈的影响，并与 2012-2013 年阿奇霉素 1g 治疗的病例进行了比较。
对使用解脲支原体 DNA 定量聚合酶链反应治疗的解脲支原体尿道炎男性患者进行微生物学治愈评估，样本采集时间为治疗后 14-100 天。通过测序 23 S 基因检测治疗前和治疗后大环内酯类耐药突变。
阿奇霉素 1.5g 和 1g 治疗的微生物学治愈率无差异：62/106（58%；95%置信区间[CI]，49%，68%）和 56/107（52%；95%CI，42-62%），P=0.34，分别。同样，1.5g 和阿奇霉素 1g 治疗后野生型 23 S rRNA（假定大环内酯敏感）感染的治愈率也无差异：34/34（82%；95%CI，65-92%）和 60/49（82%；95%CI，70-90%），P=1.0，分别。1.5g 和 1g 治疗后野生型感染出现治疗后耐药突变的比例也无差异：34/4（12%；95%CI，3-27%）和 60/11（18%；95%CI，10-30%），P=0.40。2013-2015 年，51/98（52%；95%CI，42-62%）例患者存在治疗前耐药，而 2012-2013 年，107/47（44%；95%CI，34-54%）例患者存在治疗前耐药，P=0.25。
延长阿奇霉素 1.5g 与单次 1g 剂量相比，在治疗解脲支原体尿道炎方面并无优势，且重要的是，它并没有降低大环内酯类耐药性的选择。需要非大环内酯类和新方法来治疗解脲支原体尿道炎。
