Treatment of urethritis caused by Mycoplasma Genitalium
The role of genital mycoplasmas in the etiology of NGU remains unresolved because of the wide distribution of these organisms and their frequent detection in patients who have no clinical symptoms. Some authors are inclined to attribute to the mycoplasma obligate pathogens causing urethritis, cervicitis, prostatitis, postpartum endometritis, pyelonephritis, infertility, various pathology of pregnancy and fetus. Respectively, according to these authors, should seek the eradication of mycoplasmas when they are identified. Others believe that mycoplasmas are characterized by opportunistic flora of the urogenital tract, and only under certain conditions can cause infectious-inflammatory diseases of the urinary organs. Most foreign authors refer all mycoplasma, except for M. genitalium, to conditionally pathogenic flora. That is why in the ICD-10 such diseases as mycoplasmosis, ureaplasmosis or ureaplasma infections are not registered. According to many researchers, the mycoplasmas type, without any reservations to the number of pathogens that can cause urethritis, can be attributed M. genitalium one only.
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Identification of M. genitalium in the urogenital tract is performed only by the polymerase chain reaction (PCR). The study allows quick identification of the pathogen DNA in scrapings from the urogenital tract, as well as determination of its species.
As in most cases, identifying conditionally pathogenic flora, for mycoplasmas isolated a number of factors contributing to the development of infectious and inflammatory processes. The most important of these are immune disorders, hormonal changes, massive colonization, association with other bacteria. All of these factors, as well as the type of pathogen, the duration of infection, history of prior treatment, concomitant presence of pathogenic and conditionally pathogenic flora should be considered when determining the management of patients.
Etiotropic NSU treatment caused by M. genitalium is based on the use of antibacterial drugs of different groups. The activity of drugs in relation to any infection is determined by the minimum inhibitory concentration (MIC) in studies in vitro. BMD usually correlate with clinical cure. The drug is considered optimal antibiotics with lower BMD, but the importance of bioavailability, ability to create high interstitial and intracellular concentrations, tolerability and compliance of patients should be kept in mind.
To select a scheme of adequate therapy in specific cases it is recommended to determine the sensitivity of isolated cultures to various antibiotics. But the problem is that it mainly concerns identified saprophytic flora. For example, many authors have noted the ability of mycoplasmas rapidly acquire resistance to antibiotics when passaging in vitro. Therefore, it is necessary to test patients freshly strains. Another difficulty is that the detection of mycoplasmas antibiotic sensitivity in vitro is not necessarily correlated with a positive effect in vivo. This may be due to the pharmacokinetics of drugs. These factors should be considered when assigning causal treatment, which in many cases may be part of a combination therapy, especially in mixed infections.
The European (2001) and American (2006) guidelines for the treatment of patients with urethritis contain recommendations, according to which the basic and alternative schemes can be taken.
The basic scheme implies taking:
Azithromycin - 1.0 g orally, once;
doxycycline - 100 mg 2 times a day for 7 days.
The alternative regimens can include:
erythromycin - 500 mg 4 times a day for 7 days or 500 mg two times a day for 14 days;
ofloxacin - 200 mg 2 times a day, or 400 mg 1 time per day, or 300 mg two times a day for 7 days;
levofloxacin - 500 mg 1 time per day for seven days;
Tetracycline - 500 mg 4 times a day for 7 days.
From the above schemes can be seen that the main antibiotics recommended for the treatment of NSU are drugs tetracycline, macrolides and fluoroquinolones.
doxycycline - 100 mg 2 times a day for at least 7-14 days. The first dose while taking the drug is 200 mg.
Tetracycline - 500 mg 4 times a day for 7-14 days;
Methacycline - 300 mg 4 times a day for 7-14 days.
Azithromycin - single dose 1.0 g or 250 mg 1 time per day for 6 days. The drug is taken 1 hour before meals or 2 hours after eating;
Josamycin - 500 mg 2 times a day for 7-14 days.
Erythromycin - 500 mg 4 times a day for 7-14 days;
Roxithromycin - 150 mg 2 times a day for 7-14 days;
clarithromycin - 250 mg 2 times a day for 7-14 days;
midecamycin - 400 mg three times a day for 7-14 days.
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