A Systematic Review and Meta-Analysis of Efficacy and Safety of Azithromycin Versus Moxifloxacin for the Initial Treatment of Mycoplasma genitalium Infection
Abstract
:1. Introduction
2. Results
2.1. Systematic Review
2.2. Meta-Analysis
2.2.1. Clinical Cure
2.2.2. Microbiologic Cure
2.2.3. Safety
3. Discussion
4. Materials and Methods
4.1. Data Sources and Search Strategy
4.2. Study Selection
4.3. Eligibility Criteria
4.4. Data Extraction and Risk-of-Bias Assessment
4.5. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Horner, P.J.; Gilroy, C.B.; Thomas, B.J.; Naidoo, R.O.; Taylor-Robinson, D. Association of Mycoplasma genitalium with acute non-gonococcal urethritis. Lancet 1993, 342, 582–585. [Google Scholar] [CrossRef]
- Jensen, J.S.; Orsum, R.; Dohn, B.; Uldum, S.; Worm, A.M.; Lind, K. Mycoplasma genitalium: A cause of male urethritis? Genitourin. Med. 1993, 69, 265–269. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Manhart, L.E.; Critchlow, C.W.; Holmes, K.K.; Dutro, S.M.; Eschenbach, D.A.; Stevens, C.E.; Totten, P.A. Mucopurulent cervicitis and Mycoplasma genitalium and acute endometritis. Lancet 2003, 187, 650–657. [Google Scholar]
- Manhart, L.E.; Holmes, K.K.; Hughes, J.P.; Houston, L.S.; Totten, P.A. Mycoplasma genitalium among young adults in the United States: An emerging sexually transmitted infection. Am. J. Public Health 2007, 97, 1118–1125. [Google Scholar] [CrossRef]
- Sena, A.C.; Lee, J.Y.; Schwebke, J.; Philip, S.S.; Wiesenfeld, H.C.; Rompalo, A.M.; Cook, R.L.; Hobbs, M.M. A silent epidemic: The prevalence, incidence and persistence of Mycoplasma genitalium among young, asymptomatic high-risk women in the United States. Clin. Infect. Dis. 2018, 67, 73–79. [Google Scholar] [CrossRef]
- Baumann, L.; Cina, M.; Egli-Gany, D.; Goutaki, M.; Halbeisen, F.S.; Lohrer, G.-R.; Ali, H.; Scott, P.; Low, N. Prevalence of Mycoplasma genitalium in different population groups: Systematic review and meta-analysis. Sex. Transm. Infect. 2018, 94, 255–262. [Google Scholar] [CrossRef] [Green Version]
- Totten, P.A.; Schwartz, M.A.; Sjosstrom, K.E.; Kenny, G.E.; Handsfield, H.H.; Weiss, J.B.; Whittington, W.L. Association of Mycoplasma genitalium with nongonococcal urethritis in heterosexual men. J. Infect. Dis. 2001, 183, 269–276. [Google Scholar] [CrossRef] [Green Version]
- Mena, L.A.; Mroczkowski, T.F.; Nsuami, M.; Martin, D.H. A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. Clin. Infect. Dis. 2009, 48, 1649–1654. [Google Scholar] [CrossRef] [Green Version]
- Bradshaw, C.S.; Jensen, J.S.; Tabrizi, S.N.; Read, T.R.H.; Garland, S.M.; Hopkins, C.A.; Moss, L.M.; Fairley, C.K. Azithromycin failure in Mycoplasma genitalium urethritis. Emerg. Infect. Dis. 2006, 12, 1149–1152. [Google Scholar] [CrossRef]
- Wright, A.; Grulich, A.; Roy, K.; Boyd, M.; Cornelisse, V.; Russell, D.; O’Donnell, D.; Whittaker, B.; Crooks, L.; Zablotska, I. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: Clinical guidelines. J. Virus Erad. 2017, 3, 168–184. [Google Scholar] [CrossRef]
- Jensen, J.S.; Cusini, M.; Gomberg, M.; Moi, H. 2016 European guideline on Mycoplasma genitalium infections. J. Eur. Acad. Dermatol. Venereol. 2016, 30, 1650–1656. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Jensen, J.S.; Bradshaw, C.S.; Tabrizi, S.N.; Fairley, C.K.; Hamasuna, R. Azithromycin treatment failure in Mycoplasma genitalium-positive patients with nongonococcal urethritis is associated with induced macrolide resistance. Clin. Infect. Dis. 2008, 47, 1546–1553. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gratrix, J.; Plitt, S.; Turnbull, L.; Smyczek, P.; Brandley, J.; Scarrott, R.; Naidu, P.; Parker, P.; Blore, B.; Bull, A.; et al. Prevalence and antibiotic resistance of Mycoplasma genitalium among STI clinic attendees in Western Canada: A cross-sectional analysis. BMJ Open 2017, 7, e016300. [Google Scholar] [CrossRef]
- Read, T.R.H.; Fairley, C.K.; Tabrizi, S.N.; Bissessor, M.; Lenka, V.; Chow, E.P.F.; Grant, M.; Danielewski, J.; Garland, S.M.; Hocking, J.S.; et al. Azithromycin 1.5 g over 5 days compared to 1 g single dose in urethral Mycoplasma genitalium: Impact on treatment outcome and resistance. Clin. Infect. Dis. 2017, 64, 250–256. [Google Scholar] [CrossRef] [Green Version]
- Jensen, J.S.; Bradshaw, C. Management of Mycoplasma genitalium infections-can we hit a moving target? BMC Infect. Dis. 2015, 15, 343. [Google Scholar] [CrossRef] [Green Version]
- Horner, P.; Ingle, S.M.; Garrett, F.; Blee, K.; Kong, F.; Muir, P.; Moi, H. Which azithromycin regimen should be used for treating Mycoplasma genitalium? A meta-analysis. Sex. Trasm. Infect. 2018, 94, 14–20. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Li, Y.; Le, W.J.; Li, S.; Cao, Y.P.; Su, X.H. Meta-analysis of the efficacy of moxifloxacin in treating Mycoplasma genitalium infection. Int. J. STD AIDS 2017, 28, 1106–1114. [Google Scholar] [CrossRef]
- US Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States; US Department of Health and Human Services: Atlanta, GA, USA, 2019. [Google Scholar]
- Jernberg, E.; Monghaddam, A.; Moi, H. Azithromycin and moxifloxacin for microbiological cure of Mycoplasma genitalium infection: An open study. Int. J. STD AIDS 2008, 19, 676–679. [Google Scholar] [CrossRef]
- Terada, M.; Izumi, K.; Ohki, E.; Yamagishi, Y.; Mikamo, H. Antimicrobial efficacies of several antibiotics against uterine cervicitis caused by Mycoplasma genitalium. J. Infect. Chemother. 2012, 18, 313–317. [Google Scholar] [CrossRef]
- Gundevia, Z.; Foster, R.; Jamil, M.S.; McNulty, A. Positivity at test of cure following first-line treatment for genital Mycoplasma genitalium: Follow-up of a clinical cohort. Sex. Transm. Infect. 2015, 91, 11–13. [Google Scholar] [CrossRef] [Green Version]
- Manhart, L.E.; Jensen, J.S.; Bradshaw, C.S.; Golden, M.R.; Martin, D.H. Efficacy of antimicrobial therapy for Mycoplasma genitalium infections. Clin. Infect. Dis. 2015, 61, S802–S817. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Manhart, L.E.; Gillespie, C.W.; Lowens, M.S.; Khosropour, C.M.; Colombara, D.V.; Golden, M.R.; Hakhu, N.R.; Thomas, K.K.; Hughes, J.P.; Jensen, N.L.; et al. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: A randomized controlled trial. Clin. Infect. Dis. 2013, 56, 934–942. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Machalek, D.; Tao, Y.; Shilling, H.; Jensen, J.S.; Unemo, M.; Murray, G.; Chow, E.P.F.; Low, N.; Garland, S.M.; Vodstrcil, L.; et al. Prevalence of mutations associated with resistance to macrolides and fluoroquinolones in Mycoplasma genitalium: A systematic review and meta-analysis. Lancet Infect. Dis. 2020, 20, 1302–1314. [Google Scholar] [CrossRef]
- Workowski, K.A.; Bolan, G.A.; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm. Rep. 2016, 64, 1–137. [Google Scholar]
- Bachmann, L.H.; Kirkcaldy, R.D.; Geisler, W.M.; Wiesenfeld, H.C.; Manhart, L.E.; Taylor, S.N.; Sena, A.C.; McNeil, C.J.; Newman, L.; Myler, N.; et al. Prevalence of Mycoplasma genitalium infection, antimicrobial resistance mutations, and symptom resolution following treatment of urethritis. Clin. Infect. Dis. 2020, 71, e624–e632. [Google Scholar] [CrossRef] [Green Version]
- Wood, G.E.; Jensen, N.L.; Astete, S.; Jensen, J.S.; Kenny, G.E.; Khosropour, C.M.; Gillespie, C.W.; Manhart, L.; Totten, P.A. Azithromycin and doxycycline resistance profiles of U.S. Mycoplasma genitalium strains and their association with treatment outcomes. J. Clin. Microbiol. 2021, 59, e0081921. [Google Scholar] [CrossRef]
- Hamasuna, R.; Le, P.T.; Kutsuna, S.; Furubayashi, K.; Matsumoto, M.; Ohmagari, N.; Fujimoto, N.; Matsumoto, T.; Jensen, J.S. Mutations in ParC and GyrA of moxifloxacin-resistant and susceptible Mycoplasma genitalium strains. PLoS ONE 2018, 13, e0198355. [Google Scholar]
- Lau, A.; Bradshaw, C.S.; Lewis, D.; Fairley, C.K.; Chen, M.Y.; Kong, F.Y.S.; Hocking, J.S. The efficacy of azithromycin for the treatment of genital Mycoplasma genitalium: A systematic review and meta-analysis. Clin. Infect. Dis. 2015, 61, 1389–1399. [Google Scholar] [CrossRef] [Green Version]
- The Guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement. Available online: http://prisma-statement.org (accessed on 1 December 2021).
- Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G.; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009, 6, e1000097. [Google Scholar] [CrossRef] [Green Version]
- Wells, G.A.; Shea, B.; Paterson, J. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses. 2000. Available online: http://www.ohri.ca/Programs/clinical_epidemiology/default.asp (accessed on 20 January 2022).
- Kato, H.; Hagihara, M.; Asai, N.; Shibata, Y.; Yamagishi, Y.; Iwamoto, T.; Mikamo, H. A systematic review and meta-analysis of decontamination methods to prevent hospital environmental contamination and transmission of Clostridioides difficile. Anaerobe 2021, 73, 102478. [Google Scholar] [CrossRef]
Study | Study Design | Setting | Period | Country of Study | Drug Regimen | No. of Participants | Age (Year) | Type of Infection | Susceptibility | Clinical Outcome | Risk-of-Bias Score | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Azithromycin | Moxifloxacin | |||||||||||
Bradshaw CS, 2006 | Case-control | Single-center | Mar 2004 to Nov 2005 | Australia | 1 g single dose; 1 g weekly for 3 doses | 400 mg every 24 h for 10 days | 32 vs. 6 | Median 33 (range 22–54) | Urethritis | NR | Microbiologic cure; Clinical cure | 6 |
Jernberg E, 2008 | Cohort | Single-center | May 2005 to Dec 2006 | Norway | 1 g single dose; 1 g single dose day 1, repeated after 5-7 days; 500 mg single dose day 1, 250 mg single dose the following 4 days | 400 mg every 24 h for 7 days | 319 vs. 3 | NR | Urethritis; cervicitis | NR | Microbiologic cure | 6 |
Terada M, 2012 | Retrospective cohort | Single-center | Jan 2008 to Aug 2010 | Japan | 2 g single dose; 1 g single dose | 400 mg every 24 h for 7 days; 400 mg every 24 h for 14 days | 63 vs. 84 | Range 18–42 | Cervicitis | NR | Microbiologic cure; adverse event | 6 |
Gundevia Z, 2015 | Retrospective cohort | Single-center | Aug 2009 to May 2013 | Australia | 1 g single dose; 1 g single dose day 1, 500 mg single dose the following 4 days | NR | 102 vs. 6 | Mean 30 (range 15–57) | Urethritis; cervicitis | NR | Microbiologic cure | 6 |
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Kato, H.; Hagihara, M.; Asai, N.; Hirai, J.; Yamagishi, Y.; Iwamoto, T.; Mikamo, H. A Systematic Review and Meta-Analysis of Efficacy and Safety of Azithromycin Versus Moxifloxacin for the Initial Treatment of Mycoplasma genitalium Infection. Antibiotics 2022, 11, 353. https://doi.org/10.3390/antibiotics11030353
Kato H, Hagihara M, Asai N, Hirai J, Yamagishi Y, Iwamoto T, Mikamo H. A Systematic Review and Meta-Analysis of Efficacy and Safety of Azithromycin Versus Moxifloxacin for the Initial Treatment of Mycoplasma genitalium Infection. Antibiotics. 2022; 11(3):353. https://doi.org/10.3390/antibiotics11030353
Chicago/Turabian StyleKato, Hideo, Mao Hagihara, Nobuhiro Asai, Jun Hirai, Yuka Yamagishi, Takuya Iwamoto, and Hiroshige Mikamo. 2022. "A Systematic Review and Meta-Analysis of Efficacy and Safety of Azithromycin Versus Moxifloxacin for the Initial Treatment of Mycoplasma genitalium Infection" Antibiotics 11, no. 3: 353. https://doi.org/10.3390/antibiotics11030353
APA StyleKato, H., Hagihara, M., Asai, N., Hirai, J., Yamagishi, Y., Iwamoto, T., & Mikamo, H. (2022). A Systematic Review and Meta-Analysis of Efficacy and Safety of Azithromycin Versus Moxifloxacin for the Initial Treatment of Mycoplasma genitalium Infection. Antibiotics, 11(3), 353. https://doi.org/10.3390/antibiotics11030353