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2017 ; 216
(suppl_2
): S412-S419
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New Horizons in Mycoplasma genitalium Treatment
#MMPMID28838073
Bradshaw CS
; Jensen JS
; Waites KB
J Infect Dis
2017[Jul]; 216
(suppl_2
): S412-S419
PMID28838073
show ga
Mycoplasmagenitalium is an important sexually transmitted pathogen responsible
for both male and female genital tract disease. Appreciation of its significance
in human disease has been hampered by its slow growth in culture, difficulty in
isolating it, and lack of commercial molecular-based tests for rapid detection.
Comparatively few in vitro data on antimicrobial susceptibility are available due
to the scarcity of clinical isolates and difficulty in performing susceptibility
tests to determine minimum inhibitory concentrations for M. genitalium.
Antimicrobial agents that inhibit protein synthesis such as macrolides, along
with fluoroquinolones that inhibit DNA replication, have been the treatments of
choice for M. genitalium infections. Even though international guidelines
recommend azithromycin as first-line treatment, rapid spread of macrolide
resistance as well as emergence of quinolone resistance has occurred. Increasing
rates of treatment failure have resulted in an urgent need for new therapies and
renewed interest in other classes such as aminocyclitols, phenicols, and
streptogramins as treatment alternatives. Limited data for new investigational
antimicrobials such as the ketolide solithromycin suggest that this drug may
eventually prove useful in management of some resistant M. genitalium infections,
although it is not likely to achieve cure rates >80% in macrolide-resistant
strains, in a similar range as recently reported for pristinamycin. However,
agents with completely new targets and/or mechanisms that would be less likely to
show cross-resistance with currently available drugs may hold the greatest
promise. Lefamulin, a pleuromutilin, and new nonquinolone topoisomerase
inhibitors are attractive possibilities that require further investigation.
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