P09.03 Treatment ofmycoplasma genitaliumwith azithromycin 1 g is less efficacious and associated with induction of macrolide resistance compared to a 5-day regimen

Should azithromycin 1 g be abandoned as a treatment for bacterial STIs? The case for and against

“…As no diagnostic tests are widely available commercially, management is often syndromic using azithromycin 1 g. W1 W4 Evidence is accumulating that azithromycin 1 g is only 87% efficacious in wild type infection and >10% of wild type infections develop macrolide antimicrobial resistance following treatment 5 17 18. In 2013, 1.4 million CT infections were treated in the USA (http://www.cdc.gov/std/stats13/chlamydia.htm.pdf) of which probably at least 3% were coinfected with MG, if 90% were treated with azithromycin and one assumes 12% developed antimicrobial resistance this would equate to production of 4500 separate macrolide-resistant isolates, annually, which in turn would be transmissible 16 17. Taken together this could explain the observations by Lau et al that from 2009 the efficacy of azithromycin 1 g has dropped from 87% to 67% and why MG macrolide antimicrobial resistance appears to be increasing over time and is now prevalent worldwide ranging from 20% to 100% 5 16 18…”