Failure of moxifloxacin treatment in Mycoplasma genitalium infections due to macrolide and fluoroquinolone resistance

Deborah L. Couldwell, Kaitlin A. Tagg, Neisha J. Jeoffreys, Gwendolyn L. Gilbert

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98 Citations (Scopus)

Abstract

Increasing azithromycin treatment failure in sexually transmitted Mycoplasma genitalium infection, is linked to macrolide resistance and second-line treatment relies on the fluoroquinolone, moxifloxacin. We recently detected fluoroquinolone and macrolide resistance-associated mutations in 15% and 43%, respectively, of 143 initial M. genitalium PCR-positive specimens.For a subset of 33 Western Sydney Sexual Health Centre patients, clinical information and results of sequence analysis of M. genitalium macrolide and fluoroquinolone target genes - the 23S rRNA gene, and parC and gyrA, respectively - were used to examine whether mutations were associated with treatment failure. Macrolide resistance-associated mutations correlated with microbiological (p = 0.013) and clinical (p = 0.024) treatment failure, and fluoroquinolone resistance-associated mutations with microbiological moxifloxacin treatment failure (p = 0.005). We describe the first reported cases of clinical and microbiological moxifloxacin treatment failure. Failure of first- and second-line antibiotic treatment of M. genitalium infection is occurring and likely to increase with current treatment strategies.
Original languageEnglish
Pages (from-to)822-828
Number of pages7
JournalInternational Journal of STD and AIDS
Volume24
Issue number10
DOIs
Publication statusPublished - 2013

Keywords

  • antibiotic
  • Australia
  • treatment failure
  • bacterial disease
  • location
  • Mycoplasma genitalium
  • non-gonococcal urethritis
  • resistance
  • Sexually transmitted infections
  • STI
  • treatment

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