{"doi":"10.1093/jac/dkaf142","title":"Efficacy and tolerability of the combination of minocycline and metronidazole for macrolide-resistant <i>Mycoplasma genitalium</i>","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background and objectives</jats:title>\n                  <jats:p>Curing Mycoplasma genitalium is challenging in the context of rising antimicrobial resistance and limited therapeutic options. There is an urgent need for globally relevant and effective treatment options using readily available and affordable agents. From September 2021 to August 2024 at Melbourne Sexual Health Centre, we prospectively evaluated microbial cure and tolerability of oral minocycline 100 mg combined with metronidazole 400 mg (twice daily for 14 days) for individuals with macrolide-resistant M. genitalium in whom fluroquinolones had failed or were not advised.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>Microbial cure was defined as a negative test of cure (TOC) using transcription-mediated amplification 14–90 days after completing the regimen. The proportion cured and 95% confidence intervals (CIs) were calculated. Data on side effects and adherence were collected at TOC visits.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>Microbial cure in patients receiving the combination regimen was 80.8% (95% CI: 71.9–87.8%). Cure in those who had received preceding doxycycline was 90.3% (n = 28/31, 95% CI: 74.2–98.0%) compared to 76.7% (n = 56/73, 95% CI: 65.4–85.8%) in those who had not, P = 0.172. Central nervous system and gastrointestinal side effects were commonly reported.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>Minocycline with metronidazole cured 80% of macrolide-resistant infections in this cohort. Cure may be enhanced by the use of doxycycline before the combination regimen but larger studies are needed. Given limited options for treating resistant M. genitalium infections, the combined minocycline and metronidazole regimen may represent a promising option where no alternative drugs are available, or quinolones are contraindicated. Clinicians should be aware of and discuss side effects with patients.</jats:p>\n               </jats:sec>","journal":"Journal of Antimicrobial Chemotherapy","year":2025,"id":609362,"datarank":0.32958368660043297,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"self_citation_contribution":0.32958368660043297,"citation_network_contribution":0.0,"self_endowment_contribution":0.32958368660043297,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1566193,"name":"Lenka A Vodstrcil","orcid":null,"position":1,"is_corresponding":false},{"id":1566194,"name":"Erica L Plummer","orcid":null,"position":2,"is_corresponding":false},{"id":1566195,"name":"Laura G Matthews","orcid":null,"position":3,"is_corresponding":false},{"id":1566196,"name":"Ivette Aguirre","orcid":null,"position":4,"is_corresponding":false},{"id":1566197,"name":"Eric P F Chow","orcid":null,"position":5,"is_corresponding":false},{"id":1542662,"name":"Christopher K Fairley","orcid":null,"position":6,"is_corresponding":false},{"id":1566198,"name":"Catriona S Bradshaw","orcid":null,"position":7,"is_corresponding":false},{"id":1566192,"name":"Kay Htaik","orcid":"0000-0003-1754-4920","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Efficacy and tolerability of the combination of minocycline and metronidazole for macrolide-resistant <i>Mycoplasma genitalium</i>","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background and objectives</jats:title>\n                  <jats:p>Curing Mycoplasma genitalium is challenging in the context of rising antimicrobial resistance and limited therapeutic options. There is an urgent need for globally relevant and effective treatment options using readily available and affordable agents. From September 2021 to August 2024 at Melbourne Sexual Health Centre, we prospectively evaluated microbial cure and tolerability of oral minocycline 100 mg combined with metronidazole 400 mg (twice daily for 14 days) for individuals with macrolide-resistant M. genitalium in whom fluroquinolones had failed or were not advised.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>Microbial cure was defined as a negative test of cure (TOC) using transcription-mediated amplification 14–90 days after completing the regimen. The proportion cured and 95% confidence intervals (CIs) were calculated. Data on side effects and adherence were collected at TOC visits.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>Microbial cure in patients receiving the combination regimen was 80.8% (95% CI: 71.9–87.8%). Cure in those who had received preceding doxycycline was 90.3% (n = 28/31, 95% CI: 74.2–98.0%) compared to 76.7% (n = 56/73, 95% CI: 65.4–85.8%) in those who had not, P = 0.172. Central nervous system and gastrointestinal side effects were commonly reported.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>Minocycline with metronidazole cured 80% of macrolide-resistant infections in this cohort. Cure may be enhanced by the use of doxycycline before the combination regimen but larger studies are needed. Given limited options for treating resistant M. genitalium infections, the combined minocycline and metronidazole regimen may represent a promising option where no alternative drugs are available, or quinolones are contraindicated. Clinicians should be aware of and discuss side effects with patients.</jats:p>\n               </jats:sec>","is_dataset_classified":null,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40401482","pmcid":"PMC12209785","openalex_id":"https://openalex.org/W4410602760","authors":[],"funders":[{"funder_name":"Australian NHMRC Leadership Investigator Grants","grant_id":"GNT1172900","title":null},{"funder_name":"Australian NHMRC Leadership Investigator Grants","grant_id":"GNT1173361","title":null},{"funder_name":"NHMRC Emerging Leadership Investigator Grant","grant_id":"1172873","title":null},{"funder_name":"Scholarship and Research Entry Scholarship Royal Australasian College of Physicians","grant_id":"","title":null},{"funder_name":"Australian Government Research Training Program","grant_id":"","title":null},{"funder_name":"Australian Government Research Training Program","grant_id":"","title":null},{"funder_name":"Scholarship and Research Entry Scholarship Royal Australasian College of Physicians","grant_id":"","title":null}],"total_grants":7,"fwci":4.9589,"citation_percentile":0.95855733,"influential_citations":0,"citation_trend":[{"year":2025,"count":4},{"year":2026,"count":4}],"oa_status":"hybrid","license":"cc-by","oa_locations":[{"url":"https://academic.oup.com/jac/advance-article-pdf/doi/10.1093/jac/dkaf142/63282447/dkaf142.pdf","host_type":"journal"},{"url":"https://academic.oup.com/jac/advance-article-pdf/doi/10.1093/jac/dkaf142/63282447/dkaf142.pdf","host_type":"publisher"},{"url":"https://academic.oup.com/jac/article-pdf/80/7/1878/63282447/dkaf142.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1093/jac/dkaf142","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40401482","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/12209785","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12209785","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12209785?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":["Reproductive tract infections research","Blood groups and transfusion","Acne and Rosacea Treatments and Effects","Humans","Mycoplasma genitalium","Metronidazole","Mycoplasma Infections","Anti-Bacterial Agents","Adult","Male","Minocycline","Female","Macrolides","Prospective Studies","Drug Therapy, Combination","Middle Aged","Drug Resistance, Bacterial","Treatment Outcome","Young Adult"],"mesh_terms":["Adult","Anti-Bacterial Agents","Drug Therapy, Combination","Female","Humans","Male","Metronidazole","Middle Aged","Minocycline","Mycoplasma Infections","Prospective Studies","Treatment Outcome","Macrolides","Drug Resistance, Bacterial","Mycoplasma genitalium","Young Adult"],"keywords":["Minocycline","Tolerability","Mycoplasma genitalium","Medicine","Metronidazole","Macrolide Antibiotics","Microbiology","Antibiotics","Virology","Azithromycin","Pharmacology","Biology","Erythromycin","Chlamydia trachomatis","Adverse effect"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-31T06:50:44.280911Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}