Azithromycin May Be Effective for Women With Ureaplasma urealyticum

Results of a systematic review and meta-analysis published in BMC Infectious Diseases suggest azithromycin is efficacious against Ureaplasma urealyticum.

Researchers in China searched publication databases through June 2022 for studies that assessed the efficacy of azithromycin among women with U urealyticum. A total of 7 studies, published between 1990 and 2013, were included in this analysis.

The dosing strategies for azithromycin differed among the included studies, ranging between 250 mg and 1 g, dosed once or once daily for 3 to 7 days. In regard to comparator treatment arms, 10 g of traditional Chinese medicine for 14 days was evaluated in 1 study, and doxycycline 100 mg for 1 to 14 days was evaluated in all other included studies.

The pooled patient population comprised 240 patients who received azithromycin and 272 who received a comparator treatment.

Azithromycin had comparable effects for the treatment of U urealyticum relative to the pooled control arms in both fixed- (risk ratio [RR], 1.03; 95% CI, 0.94-1.12) and random-effects models (RR, 0.98; 95% CI, 0.80-1.20). However, significant heterogeneity was noted (I², 66%; P <.01).

Stratified by type of comparator treatment, the effects of azithromycin against U urealyticum were similar to that of traditional Chinese medicine (RR, 0.71; 95% CI, 0.37-1.34) and doxycycline, both in fixed- (RR, 1.04; 95% CI, 0.95-1.13) and random-effects models (RR, 1.00; 95% CI, 0.81-1.24). As with the main analysis, comparisons against doxycycline alone showed significant heterogeneity (I², 70%; P <.01).

In dose-specific analyses, a similar therapeutic effect was observed between azithromycin and oral doxycycline 1 mg in both fixed- (RR, 0.99; 95% CI, 0.88-1.12) and random-effects models (RR, 0.99; 95% CI, 0.88-1.12). Further comparison between azithromycin and oral doxycycline 0.5 g daily for 7 days also showed similar therapeutic effect in both fixed- (RR, 1.02; 95% CI, 0.87-1.20) and random-effects models (RR, 0.87; 95% CI, 0.44-1.68), though significant heterogeneity was observed (I², 92%; P <.01).

Study limitations include small sample sizes and the inability to draw conclusions about the safety of azithromycin against U urealyticum due to insufficient data.

According to the researchers, “[A]zithromycin has a comparable therapeutic effect on Ureaplasma urealyticum infection in the female reproductive tract compared to other antibiotics.”