Which azithromycin regimen should be used for treating Mycoplasma genitalium A meta-analysis

Patrick Horner*, Suzanne M. Ingle, Frederick Garrett, Karla Blee, Fabian Kong, Peter Muir, Harald Moi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

44 Citations (Scopus)


Background There is increasing evidence that azithromycin 1 g is driving the emergence of macrolide resistance in Mycoplasma genitalium worldwide. We undertook a meta-analysis of M. genitalium treatment studies using azithromycin 1 g single dose and azithromycin 500 mg on day 1 then 250 mg daily for 4 days (5-day regimen) to determine rates of treatment failure and resistance in both regimens. Methods The online databases PubMed and Medline were searched using terms "Mycoplasma genitalium", "macrolide"or "azithromycin"and "resistance"up to April 2016. Studies were eligible if they: used azithromycin 1 g or 5 days, assessed patients for macrolide resistant genetic mutations prior to treatment and patients who failed were again resistance genotyped. Random effects meta-analysis was used to estimate failure and resistance rates. Results Eight studies were identified totalling 435 patients of whom 82 (18.9) had received the 5-day regimen. The random effects pooled rate of treatment failure and development of macrolide antimicrobial resistance mutations with azithromycin 1 g was 13.9 (95 CI 7.7 to 20.1) and 12.0 (7.1 to 16.9), respectively. Of individuals treated with the 5-day regimen, with no prior doxycycline treatment, fewer (3.7; 95 CI 0.8 to 10.3, p=0.012) failed treatment, all of whom developed resistance (p=0.027). Conclusion Azithromycin 1 g is associated with high rates of treatment failure and development of macrolide resistance in M. genitalium infection with no pre-existing macrolide mutations. There is moderate but conflicting evidence that the 5-day regimen may be more effective and less likely to cause resistance.

Original languageEnglish
Pages (from-to)14-20
Number of pages7
JournalSexually Transmitted Infections
Issue number1
Publication statusPublished - 1 Feb 2018

Bibliographical note

Funding Information:
Funding This work was supported by the National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England (PHE).

Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.


  • Azithromycin
  • Doxycycline
  • Drug resistance
  • Meta-analysis
  • Mutation
  • Mycoplasma genitalium


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