<i>Mycoplasma genitalium</i> treatment strategies in the era of significant macrolide resistance: Findings from a multi-centre audit in Northwest England

IntroductionAzithromycin is first-line for uncomplicated <i>Mycoplasma genitalium</i> (Mgen) treatment in UK and European guidelines, however the rates of azithromycin resistance have increased significantly in recent years leading to higher rates of treatment failure. This study aims to review the disease epidemiology to guide service improvement.MethodsWe undertook a retrospective case note review of 1036 persons treated for Mgen over 1067 Mgen-related attendances. We obtained data on demographics, site(s) of infection, antibiotic resistance, treatment regimen received and results of test of cure.Results71.1% (<i>n</i> = 759) patients received the recommended first-line regimen of doxycycline and azithromycin. Moxifloxacin is the recommended first-line management for macrolide-resistant or complicated infection. 15% (<i>n</i> = 155) patients received moxifloxacin alone as first-line treatment, and 6.9% (<i>n</i> = 72) patients received doxycycline and moxifloxacin dual therapy. 72.9% (<i>n</i> = 753) samples were successfully tested for macrolide resistance. Of these, 55.5% (<i>n</i> = 418) showed macrolide resistance. 20.6% (<i>n</i> = 7) showed fluoroquinolone resistance.ConclusionsResistance data show a macrolide resistance rate of 55.5% across our region, and at least 1 in 10 persons were inappropriately screened for Mgen. We propose a multi-pronged approach which includes strict adherence to testing criteria, local resistance testing, resistance-guided management as well as innovative approaches to improve test of cure rates.