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New Horizons in Mycoplasma genitalium Treatment.

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords

Mycoplasma genitalium

antimicrobial resistance

new treatments

Journal Title the journal of infectious diseases
Publication Year Start




PMID- 28838073
OWN - NLM
STAT- MEDLINE
DA  - 20170825
DCOM- 20170905
LR  - 20170906
IS  - 1537-6613 (Electronic)
IS  - 0022-1899 (Linking)
VI  - 216
IP  - suppl_2
DP  - 2017 Jul 15
TI  - New Horizons in Mycoplasma genitalium Treatment.
PG  - S412-S419
LID - 10.1093/infdis/jix132 [doi]
AB  - 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.
CI  - (c) The Author 2017. Published by Oxford University Press for the Infectious
      Diseases Society of America. All rights reserved. For permissions, e-mail:
      [email protected]
FAU - Bradshaw, Catriona S
AU  - Bradshaw CS
AD  - Central Clinical School, Monash University.
AD  - Melbourne Sexual Health Centre, Alfred Hospital, Melbourne, Australia.
FAU - Jensen, Jorgen S
AU  - Jensen JS
AD  - Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
FAU - Waites, Ken B
AU  - Waites KB
AD  - Department of Pathology, University of Alabama at Birmingham.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Infect Dis
JT  - The Journal of infectious diseases
JID - 0413675
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Fluoroquinolones)
RN  - 0 (Quinolines)
RN  - 0 (Streptogramins)
RN  - 0 (Tetracyclines)
RN  - 83905-01-5 (Azithromycin)
RN  - 93AKI1U6QF (Spectinomycin)
RN  - E66400VT9R (quinoline)
RN  - FLQ7571NPM (Thiamphenicol)
SB  - AIM
SB  - IM
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Azithromycin/therapeutic use
MH  - Drug Discovery/*classification
MH  - Drug Resistance, Bacterial
MH  - Female
MH  - Fluoroquinolones/therapeutic use
MH  - Humans
MH  - Male
MH  - Microbial Sensitivity Tests
MH  - Mycoplasma Infections/*diagnosis/*drug therapy
MH  - Mycoplasma genitalium
MH  - Quinolines/therapeutic use
MH  - Spectinomycin/therapeutic use
MH  - Streptogramins/therapeutic use
MH  - Tetracyclines/therapeutic use
MH  - Thiamphenicol/therapeutic use
MH  - Treatment Failure
OTO - NOTNLM
OT  - Mycoplasma genitalium
OT  - antimicrobial resistance
OT  - new treatments
EDAT- 2017/08/26 06:00
MHDA- 2017/09/07 06:00
CRDT- 2017/08/26 06:00
AID - 4040966 [pii]
AID - 10.1093/infdis/jix132 [doi]
PST - ppublish
SO  - J Infect Dis. 2017 Jul 15;216(suppl_2):S412-S419. doi: 10.1093/infdis/jix132.