Guide to therapy
Guidelines for Mgen infections now recommend testing for macrolide resistance to help determine appropriate treatment.11,12,13
When applying resistance-guided therapy to a population with high levels of antibiotic resistance and cure rates below 67%, patient outcome was significantly improved.12
Cure rates in the Mgen macrolide-susceptible population exceeded 94%. Using doxycycline for initial STI treatment reduces overall use of azithromycin and reduces initial bacterial load which may improve subsequent Mgen treatment.7
Resistance treatment failure
With increasing antibiotic resistance, there is a need to detect mutations conferring macrolide resistance when they are present.
Mgen treatment failures can occur when using doxycycline, azithromycin and moxifloxacin. Microbiologic cure rates are poor with either doxycycline or azithromycin monotherapy (~50% or less). Microbiologic cure rates for moxifloxacin were initially high (close to 100%) but have declined to 89% in studies conducted from 2010-2017.10