Abstract
Mycoplasma genitalium is recognized as a remarkable pathogen since azithromycin-resistant strains and treatment failure have been increasingly reported. Nevertheless, international guidelines still recommend azithromycin as a first-line treatment and moxifloxacin as a second-line treatment. We performed a systematic review and meta-analysis to validate the efficacy and safety of both drugs in the initial treatment of M. genitalium. We systematically searched the EMBASE, PubMed, Scopus, Ichushi, and CINAHL databases up to December 2021. We defined efficacy as clinical and microbiologic cure, and safety as persistent diarrhea. Overall, four studies met the inclusion criteria: one showed clinical cure (azithromycin treatment, n = 32; moxifloxacin treatment, n = 6), four showed microbiologic cure (n = 516; n = 99), and one showed safety (n = 63; n = 84). Moxifloxacin improved the microbiologic cure rate compared with azithromycin (odds ratio [OR] 2.79, 95% confidence interval [CI], 1.06–7.35). Clinical cure and safety did not show a significant difference between azithromycin and moxifloxacin treatments (OR 4.51, 95% CI 0.23–88.3; OR 0.63, 95% CI 0.21–1.83). Our meta-analysis showed that moxifloxacin was more effective than azithromycin at eradicating M. genitalium infections and supports its preferential use as a first-line treatment.
Highlights
Mycoplasma genitalium is a small bacterium belonging to the Mycoplasmataceae family and is implicated in the etiology of nongonococcal urethritis in men and cervicitis in women [1–3]
Our meta-analysis showed superior microbiological cure rate in patients treated with moxifloxacin compared with patients treated with azithromycin
All patients treated with moxifloxacin improved clinical cure, whereas 15% of patients treated with azithromycin did not improve clinical cure
Summary
Mycoplasma genitalium is a small bacterium belonging to the Mycoplasmataceae family and is implicated in the etiology of nongonococcal urethritis in men and cervicitis in women [1–3]. Since M. genitalium does not have peptidoglycancontaining cell walls, treatment options are limited to antibiotics that disrupt protein synthesis (macrolides such as azithromycin, and tetracyclines such as doxycycline) or DNA replication (quinolones such as moxifloxacin). Clinical trials reported superior efficacy of azithromycin with a failure rate of 16% compared with doxycycline [8]. It has been reported that the efficacy of moxifloxacin in patients with azithromycin treatment failure was 100%, with high in vitro susceptibility [9]. International guidelines recommend azithromycin as a first-line treatment and moxifloxacin as a second-line treatment [10,11]. Resistance to both antibiotics and treatment failure have recently been reported
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