多西环素-莫西沙星序贯疗法治疗生殖支原体尿道炎/宫颈炎的临床观察

Doxycycline-moxifloxacin sequential therapy for Mycoplasma genitalium urethritis/cervicitis:a clinicalobservation

目的观察多西环素-莫西沙星序贯疗法对生殖支原体尿道炎/宫颈炎的治疗结局和安全性。方法2019年6月至2020年12月在中国医学科学院皮肤病医院性病门诊连续招募经核酸检测确诊的生殖支原体尿道炎/宫颈炎患者,给予多西环素7 d继以莫西沙星7 d的序贯疗法,治疗结束后2~3周行病原学或临床判愈。采用Fisher确切概率法分析治疗结局相关影响因素。结果纳入合格受试者36例,男30例,女6例。18例(50%)完成了治疗后的病原学复测,其中12例达病原学治愈,6例治疗失败;另18例获临床治愈。多西环素-莫西沙星序贯疗法治疗生殖支原体尿道炎/宫颈炎的总体有效率为83.3%(30/36,95%CI:70.5%,96.1%),治疗结局与患者年龄、性别、婚姻状态、近1个月性伴数、性病史、近1个月抗生素用药史及合并感染均无显著关联(均P>0.05)。结论多西环素-莫西沙星序贯疗法对南京地区生殖支原体感染的疗效有限,临床上应用该方案时应警惕治疗失败可能。

Objective To investigate outcomes and safety of doxycycline-moxifloxacin sequential regimen in the treatment of Mycoplasma genitalium urethritis/cervicitis.MethodsFrom June 2019 to December 2020,patients with Mycoplasma genitalium urethritis/cervicitis confirmed by nucleic acid amplification testing were successively recruited at Department of Sexually Transmitted Diseases,Hospital of Dermatology,Chinese Academy of Medical Sciences,and received sequential therapy with oral doxycycline for 7 days followed by oral moxifloxacin for 7 days.Clinical and/or etiological assessment was conducted 2 to 3 weeks after the end of treatment.Fisher's exact test was used to analyze factors influencing the treatment outcome.ResultsTotally,36 eligible subjects were enrolled,including 30 males and 6 females.Among them,18(50%)patients completed post-treatment etiological assessment,which showed that 12 achieved microbiological cure,and treatment failures occurred in 6;another 18 patients achieved clinical cure.The overall response rate to doxycycline-moxifloacin sequential therapy was 83.3%(30/36,95%confidence interval[CI]:70.5%,96.1%).The treatment outcome showed no significant association with the patients'age,gender,marital status,number of sexual partners in the past 1 month,history of sexually transmitted diseases,history of antibiotic use in the past 1 month,or co-infections(all P>0.05).ConclusionThe efficacy of doxycycline-moxifloacin sequential regimen is limited in the treatment of Mycoplasma genitalium infections in Nanjing area,and clinicians should be alerted to the possibility of treatment failure in clinical practice.