Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection

Abstract

Mycoplasma genitalium is an important pathogen that is transmitted through sexual contact. For patients diagnosed with M. genitalium infection, the current guidelines recommend 1 g of azithromycin as the first-line treatment. Moxifloxacin is used as a second-line drug due to its remarkable efficacy; however, increased use of moxifloxacin to treat M. genitalium infections has caused the emergence of cases of moxifloxacin treatment failure. This meta-analysis aims to estimate the treatment efficacy of moxifloxacin for M. genitalium infection. Electronic databases were searched for articles published from 1983 to the end of May 2016 using the following search terms: ( Mycoplasma genitalium) AND (moxifloxacin OR 1-cyclopropyl-7-(2,8-diazabicyclo(4.3.0)non-8-yl)-6-fluoro-8-methoxy-1,4-dihydro-4-oxo-3-quinoline carboxylic acid OR Proflox OR moxifloxacin hydrochloride OR Octegra OR Avelox OR Avalox OR Izilox OR Actira OR [treatment efficacy]). All included studies were published in English; all participants were diagnosed with M. genitalium infection, and microbial cure times were measured within 12 months after treatment. Treatment efficacy was measured as microbial cure at the final follow-up after treatment. In total, 17 studies including 252 participants met the inclusion criteria. The majority of these studies were observational. The random-effects pooled microbial cure rate was 96% (95% confidence interval [CI], 90%-99%; I= 28.59%, P = 0.13). For studies with sample collection deadlines prior to 2010, the pooled microbial cure rate was 100% (95% CI, 99%-100%; I= 0.00%, P = 1.00). For studies with sample collection deadlines of 2010 and later, the pooled microbial cure rate was 89% (95% CI, 82%-94%; I= 0.00%, P = 0.59). The elimination rate of moxifloxacin for M. genitalium infection has decreased from 100% to 89% since 2010. This decline merits considerable attention. We suggest close follow-up to investigate the efficacy of moxifloxacin for treating M. genitalium infections. Additionally, sentinel points should be established to detect mutations in the gyrA/B and parC/E genes, which are associated with moxifloxacin resistance.

Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at an STI Clinic in Guangzhou, China, 2016-2018.

“…The uoroquinolone moxi oxacin, another medication extensively used as a second-line bactericidal, has a cure rate approaching 100% in infections with susceptible strains [36]. In recent years, the e cacy of moxi oxacin failure rate has also been noted, rst in Japan [7] and later in Australia [37][38][39]. The elimination rate of moxi oxacin for M. genitalium infection has decreased from 100% to 89% since 2010 [37].…”

Prevalence and antibiotic resistance of rectal Mollicutes in HIV-infected men who have sex with men at the University Hospital of Dresden, Germany

“…The study from Germany calculated a rate of 80% macrolide-resistant strains [22]. Quinolone resistance and treatment failures are being reported especially from the Asian Pacific region [28][29][30] reaching nearly 90% in China [31]. So far, data from Europe on quinolone resistance are relatively limited.…”

Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at an STI Clinic in Guangzhou, China, 2016-2018.

“…Fluoroquinolone moxifloxacin, another medication extensively used as a second-line bactericidal, has a cure rate approaching 100% in infections with susceptible strains [46]. In recent years, an increasing moxifloxacin treatment failure rate has also been noted, first in the Asia-Pacific region [7] and later in Australia [47]. Indications point to an emergence of fluoroquinolone resistant strains [47][48][49].…”

“…In recent years, an increasing moxifloxacin treatment failure rate has also been noted, first in the Asia-Pacific region [7] and later in Australia [47]. Indications point to an emergence of fluoroquinolone resistant strains [47][48][49]. The elimination rate of moxifloxacin for M. genitalium infection has decreased from 100-89% since 2010 [47].…”

“…Indications point to an emergence of fluoroquinolone resistant strains [47][48][49]. The elimination rate of moxifloxacin for M. genitalium infection has decreased from 100-89% since 2010 [47].…”