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

De novo mutations drive the spread of macrolide-resistant Mycoplasma genitalium: a mathematical modelling study

“…The focus should be on strategies to improve surveillance of de novo antimicrobial resistant M. genitalium infections and to improve the management of symptomatic infection, whilst minimising the emergence of resistance since resistance to second line treatment with moxifloxacin is already increasing [6]. Calls to abandon treatment of uncomplicated NGU with single dose azithromycin [24,[47][48][49] and to return to doxycycline [50] are increasing.…”

“…The focus should be on strategies to improve surveillance of antimicrobial resistant M. genitalium infections and to improve the management of symptomatic infection, whilst minimising the emergence of resistance. Calls to abandon treatment of uncomplicated NGU with single dose azithromycin [23,[43][44][45] and to return to doxycycline [46] are increasing. Despite concerns about limited efficacy of doxycycline, a large randomised controlled trial conducted in the US from 2007 to 2011 found that both clinical and microbiological cure rates for doxycycline and azithromycin were comparable [47].…”

Highlighting the clinical need for diagnosing Mycoplasma genitalium infection

“…7 These symptoms and signs are also commonly associated with Chlamydia trachomatis and patients when treated syndromically are likely to be prescribed azithromycin 1 g, which was a recommended first line therapy for chlamydial infection until recently. [8][9][10][11] There is, therefore, a clear need to identify MG infection 5 and treat correctly to avoid inappropriate or sub-optimal treatment, which is associated with the development of resistance. 5 The worldwide focus on antimicrobial stewardship must be considered against the background of extreme financial pressure which impacts healthcare provision in every country.…”

“…3,4,7 Although the optimal treatment for MG is unclear, treatment with azithromycin 1 g, which is associated with the development of macrolide resistance, is not recommended. [6][7][8]13 This study assesses the attitudes of clinical professionals involved in the diagnosis and management of conditions associated with MG infection in order to make appropriate recommendations for best practice.…”

Highlights from this issue

“…This has been the subject of considerable debate3 – this month, Björnelius et al (page ) report low rates of macrolide resistance in Mycoplasma genitalium in Sweden. They hypothesize that this could be due to use of doxycycline as first line treatment for Chlamydia trachomatis .…”