Ando Naokatsu, Mizushima Daisuke, Takano Misao, Mitobe Morika, Kobayashi Kai, Kubota Hiroaki, Miyake Hirofumi, Suzuki Jun, Sadamasu Kenji, Aoki Takahiro, Watanabe Koji, Oka Shinichi, Gatanaga Hiroyuki
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Microbiology, Tokyo Metropolitan Institute for Public Health, Tokyo, Japan.
J Antimicrob Chemother. 2025 Jan 3;80(1):247-253. doi: 10.1093/jac/dkae403.
Mycoplasma genitalium, which causes sexually transmitted diseases, is increasingly resistant to key antibiotics such as macrolides and quinolones, posing a challenge for treatment.
To assess the effectiveness of prolonged sitafloxacin and doxycycline combination therapy as a new alternative treatment strategy for highly drug-resistant M. genitalium strains.
A prospective cohort study was conducted at the National Center for Global Health and Medicine, Tokyo, Japan, from 1 January 2020 to 31 October 2022. Patients with M. genitalium urogenital or rectal infections and those who did not receive the initial sitafloxacin monotherapy were included. Patients were administered sitafloxacin and doxycycline for 21 days as salvage therapy. M. genitalium isolates were tested for parC, gyrA and 23S rRNA resistance-associated mutations.
Twenty-seven patients received the combination therapy. All M. genitalium strains available for resistance analysis had parC (24/24) and macrolide resistance-associated (25/25) mutations, and 68% (17/25) had gyrA mutations. The overall cure rate was 77.8%. For strains with concurrent parC and gyrA mutations, the cure rate was 68.8% (P = 0.053) compared with that for monotherapy (37.5%).
Prolonged combination therapy is highly effective against M. genitalium strains with concurrent parC and gyrA mutations. Future research should focus on establishing the optimal treatment duration and monitoring the risk of resistance.
引起性传播疾病的生殖支原体对大环内酯类和喹诺酮类等关键抗生素的耐药性日益增强，给治疗带来了挑战。
评估延长西他沙星和多西环素联合治疗作为高度耐药生殖支原体菌株新的替代治疗策略的有效性。
2020年1月1日至2022年10月31日在日本东京国立全球健康与医学中心进行了一项前瞻性队列研究。纳入患有生殖支原体泌尿生殖道或直肠感染且未接受初始西他沙星单药治疗的患者。患者接受西他沙星和多西环素联合治疗21天作为挽救治疗。对生殖支原体分离株进行parC、gyrA和23S rRNA耐药相关突变检测。
27例患者接受了联合治疗。所有可用于耐药性分析的生殖支原体菌株均有parC（24/24）和大环内酯类耐药相关（25/25）突变，68%（17/25）有gyrA突变。总体治愈率为77.8%。对于同时存在parC和gyrA突变的菌株，与单药治疗（37.5%）相比，治愈率为68.8%（P = 0.053）。
延长联合治疗对同时存在parC和gyrA突变的生殖支原体菌株非常有效。未来的研究应集中在确定最佳治疗持续时间和监测耐药风险上。
