Journal Article Ahead of print
PubMed: 42100861 DOI: 10.1093/infdis/jiag251
Declining efficacy of moxifloxacin for Mycoplasma genitalium infection: time for fluoroquinolone-resistance guided therapy?
J Infect Dis
Authors: Laura G Matthews, Lenka A Vodstrcil, Natasha L Wild, Erica L Plummer, Ivette Aguirre, Kay Htaik, Gerald L Murray, Vesna De Petra, Michelle Sait, Norelle Sherry, Catriona S Bradshaw
Affiliations
- Melbourne Sexual Health Centre, Bayside Health, Melbourne, Victoria, Australia. School of Translational Medicine, Monash University, Melbourne, Victoria, Australia. Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
- Melbourne Sexual Health Centre, Bayside Health, Melbourne, Victoria, Australia.
- School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
- Department of Obstetrics, Gynaecology, and Newborn Health, The University of Melbourne, Parkville, Victoria, Australia.
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
- Department of Infectious Diseases and Immunology, Austin Health, Heidelberg, Victoria, Australia.
Abstract
BACKGROUND
We assessed trends in moxifloxacin-use and efficacy for MG over a decade at Melbourne Sexual Health Centre (MSHC). Specific Mycoplasma genitalium (MG) mutations, namely ParC-S83I, have been associated with moxifloxacin failure. In 2024 MSHC introduced ParC-S83 testing, recommending moxifloxacin for ParC-S83 wildtype infections and alternative regimens if the ParC-S83I mutation was detected. We present preliminary impacts of ParC-S83 testing on moxifloxacin-use and efficacy.
METHODS
Clients with MG from 2015-2024 were treated with doxycycline preceding macrolide-resistance guided azithromycin or moxifloxacin. Clients with a test-of-cure 14-90 days after completing moxifloxacin who reported >50% adherence and no condomless sex prior to test-of-cure were eligible for efficacy analyses. Proportions with 95% confidence intervals (CIs) were calculated for moxifloxacin-use and efficacy, with trends assessed by logistic regression. Moxifloxacin-use and efficacy were compared in the 12-months before and after introduction of the ParC-S83 assay.
RESULTS
From 2015-2024, 2,611/5,739 MG infections received moxifloxacin. Moxifloxacin-use increased from 6.7% (n=19/282; 95%CI:4.1-10.3%) in 2015 to 60.3% (n=482/800; 95%CI:56.8-63.7%) in 2023 (ptrend<0.0001). Efficacy analyses included 1,623 infections. Moxifloxacin-efficacy decreased from 100% (n=11/11) in 2015 to 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 (ptrend=0.007). After introduction of the ParC-S83 assay, moxifloxacin-use decreased from 60.3% (n=482/800, 95%CI:56.8-63.7%) in 2023 to 49.2% (n=438/890, 95%CI:45.9-52.6%) in 2024 (p<0.0001) and cure increased from 79.3% (n=238/300, 95%CI:74.3-83.8%) in 2023 to 89.2% (n=116/130, 95%CI:82.6-94.0%, p=0.013) in ParC-S83 wildtype infections.
CONCLUSIONS
Increasing moxifloxacin-use and declining efficacy reflects rising resistance in our region. Preliminary data suggests a ParC-S83 assay has the potential to improve moxifloxacin- use and cure in this setting.
MeSH
Research Design, Moxifloxacin, Fluoroquinolones, Therapeutics, Mycoplasma, Communicable Diseases, Mutation, Mycoplasma Genitalium, Infections