Efficacy of minocycline versus pristinamycin-based regimens for the treatment of Mycoplasma genitalium infections: a scoping review

BACKGROUND: In the current scenario where dual-class resistance to both macrolides and fluoroquinolones in M. genitalium is emerging, alternatives are scarce. OBJECTIVES: We aim to estimate the efficacy of minocycline and pristinamycin-based regimens for the treatment of M. genitalium infections. METHODS: On November 2025, two independent Boolean searches were performed in PubMed using the MeSH terms " Mycoplasma genitalium " AND "minocycline", and " Mycoplasma genitalium " AND "pristinamycin", respectively, to identify manuscripts reporting treatment outcomes in M. genitalium urogenital infections using minocycline and/or pristinamycin-based regimens. Regarding minocycline, six original research studies were finally included for the primary outcome, accounting for 274 M. genitalium infection cases. On the other hand, six studies were also included regarding pristinamycin (three records overlapping with the other search), accounting for 223 M. genitalium cases. RESULTS: The aggregated data estimated that the rate of treatment failure associated with minocycline was 71/274 (25.9%% CI, 20.7%-31.1%]), similar to the one estimated for pristinamycin-based therapies of 56/223 (25.1% [95% CI, 19.6%-31.3%]); P = 0.839. CONCLUSIONS: This review provides comprehensive evidence-based data regarding the efficacy of minocycline and pristinamycin-based regimens for the treatment of M. genitalium infections. Consequently, this work presents a consolidated analysis to help support updates to clinical guidelines, suggesting the preferential use of minocycline over pristinamycin for the treatment of multidrug resistant infections due to its greater accessibility and lower cost.