Pristinamycin Effective, Well-Tolerated Treatment for Mycoplasma genitalium

Mycoplasma bacteria
Mycoplasma bacteria
The increasing prevalence of macrolide resistance underscores the need for research focused on identifying a safe and effective treatment for Mycoplasma genitalium.

Pristinamycin is a well-tolerated option to treat Mycoplasma genitalium when fluoroquino­lones have failed or cannot be used, according to research reported in Emerging Infectious Diseases.

Cure rates for sexually transmitted infections commonly treated with azithromycin, including M genitalium, have reportedly dropped. The effectiveness of pristinamycin was therefore investigated in M genitalium cases where treatment with prior azithromycin, moxifloxacin, or doxycycline failed.

In total, 114 patients were treated with pristinamycin, of which data on bacterial load was available for 99. Following  treatment 75% of patients were cured, and this did not change depending on daily dosages of 2 g or 4 g, or combination pristinamycin 3 g with 200 mg doxycycline. In patients with higher bacterial load, treatment was twice as likely to fail with each 1 log10 increase in bacterial load. Bacterial load was also the only significant factor associated with treatment failure. 

Adverse effects were uncommon in all patients; overall, 7% of patients experienced gastrointestinal adverse effects.

Pristinamycin was listed in European guidelines in 2016 as the third choice for M genitalium infection, and the results of this study do not support a change to this. In light of increased macrolide resistance, however, pristinamycin may have a role to play in treating this neglected infection when quinolones are contraindicated or ineffective. “These data highlight the urgent need for further work to determine the activity of new and existing antimicrobial drugs, and combinations of antimicrobial drugs” against M genitalium.

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Read TRH, Jensen JS, Fairley CK, et al. Use of pristinamycin for macrolide-resistant Mycoplasma genitalium infection. Emerg Infect Dis. 2018;24(2):328-335.