Doxycycline-Quinolone Sequential Therapy Shows Lower Failure, Recurrence vs Azithromycin for MG
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Key Takeaway
Consider sequential doxycycline-quinolone therapy for MG, but note evidence is observational.
This retrospective cohort study evaluated 1,192 sexually active adults with nucleic acid amplification test (NAAT)-confirmed Mycoplasma genitalium infection at a single tertiary hospital in China from 2018 to 2024. The analysis compared doxycycline-quinolone sequential therapy to azithromycin monotherapy, with 474 patients completing follow-up. The primary outcomes were treatment failure (persistent infection at 8 weeks and ultimate failure) and recurrence, with follow-up at 8 weeks for persistence and long-term for ultimate failure and recurrence.
Patients receiving the sequential therapy had significantly lower adjusted odds of ultimate treatment failure (aOR=0.36, 95%CI: 0.21-0.61) and recurrence (aOR=0.37, 95%CI: 0.18-0.75) compared to those receiving azithromycin. The median time to clearance was 7 weeks with sequential therapy versus 10 weeks with azithromycin (p=0.001), though the mean clearance time showed a marked long-tail effect in the azithromycin group (94.2 vs 28.0 weeks). Co-infection with Chlamydia trachomatis was identified as the strongest independent predictor of ultimate failure (aOR=3.21, 95%CI: 1.88-5.48).
Safety and tolerability data were not reported. The study has several limitations inherent to its retrospective, single-center design, including potential selection bias and unmeasured confounding. The funding source and author conflicts of interest were also not reported. While the findings suggest a potential advantage for sequential therapy in this setting, they should be interpreted cautiously as observational evidence. The authors advocate for risk-stratified initial therapy, but prospective, randomized data are needed to confirm these results and establish causal efficacy.
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View Original Abstract ↓
BackgroundThe management of Mycoplasma genitalium (MG) infection is challenged by rising macrolide resistance, leading to high failure rates with azithromycin. Evidence on the long-term effectiveness of alternative initial regimens, particularly sequential therapy, and easily obtainable predictors for poor outcomes remains scarce.MethodsWe conducted a retrospective cohort study at a tertiary hospital in China (2018-2024). Sexually active adults with nucleic acid amplification test (NAAT)-confirmed MG infection and available treatment records were included. The primary outcomes were treatment failure (persistent infection at 8 weeks, ultimate failure) and recurrence. Multivariable logistic regression and Kaplan-Meier survival analyses were employed to assess the impact of initial antibiotic regimens (azithromycin, quinolones, doxycycline-quinolone sequential therapy), demographics, and co-infections.ResultsAmong 1, 192 MG-positive patients, 474 completed follow-up. After adjustment, doxycycline-quinolone sequential therapy was associated with significantly lower odds of ultimate treatment failure (adjusted odds ratio [aOR]=0.36, 95%CI:0.21-0.61) and recurrence (aOR=0.37, 95%CI:0.18-0.75) compared to azithromycin. Survival analysis confirmed a faster median time to clearance with sequential therapy (7 vs. 10 weeks, p=0.001) and a marked “long-tail” effect in the azithromycin group (mean clearance time: 94.2 vs. 28.0 weeks). Co-infection with Chlamydia trachomatis (CT) was the strongest independent predictor for all adverse outcomes (aOR for ultimate failure=3.21, 95%CI:1.88-5.48), followed by male sex.ConclusionsIn this real-world cohort, doxycycline-quinolone sequential therapy demonstrated superior long-term effectiveness over azithromycin for MG infection. CT co-infection and male sex were key risk predictors. These findings advocate for a paradigm shift towards risk-stratified initial therapy, prioritizing sequential regimens for high-risk patients to improve cure rates while supporting antimicrobial stewardship.
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