Treatment of genital mycoplasma in colonized pregnant women in late pregnancy is associated with a lower rate of premature labour and neonatal complications.

Mycoplasma hominis and Ureaplasma spp. may colonize the human genital tract and have been associated with adverse pregnancy outcomes such as preterm labour and preterm premature rupture of membranes. However, as these bacteria can reside in the normal vaginal flora, there are controversies regarding their true role during pregnancy and so the need to treat these organisms. We therefore conducted a retrospective analysis to evaluate the treatment of genital mycoplasma in 5377 pregnant patients showing symptoms of potential obstetric complications at 25-37 weeks of gestation. Women presenting with symptoms were routinely screened by culture for the presence of these bacteria and treated with clindamycin when positive. Compared with uninfected untreated patients, women treated for genital mycoplasma demonstrated lower rates of premature labour. Indeed preterm birth rates were, respectively, 40.9% and 37.7% in women colonized with Ureaplasma spp. and M. hominis, compared with 44.1% in uncolonized women (Ureaplasma spp., p 0.024; M. hominis, p 0.001). Moreover, a reduction of neonatal complications rates was observed, with 10.9% of newborns developing respiratory diseases in case of Ureaplasma spp. colonization and 5.9% in the presence of M. hominis, compared with 12.8% in the absence of those bacteria (Ureaplasma spp., p 0.050; M. hominis, p <0.001). Microbiological screening of Ureaplasma spp. and/or M. hominis and pre-emptive antibiotic therapy of symptomatic pregnant women in late pregnancy might represent a beneficial strategy to reduce premature labour and neonatal complications.

[Clinical application research of feilinjian peroral liquid in the treatment of Chlamydia and Mycoplasma infectious prostatitis].

OBJECTIVES: To evaluate the validity and security of Feilinjian peroral liquid in the treatment of chlamydia trachomatis (CT), mycoplasma hominis (Mh) and Ureaplasma urealyticum (UU) infectious prostatitis. METHODS: Two hundred and three patients of CT, Mh or UU infectious prostatitis diagnosed by strict orientation examination were randomly divided into two groups, one given feilinjian peroral liquid, and the other azithromycin perorally, for one month as treatment period. RESULTS: The analytical results showed that 54 (42.86%) were clinically fully recovered, 32(32.39%) were significantly effective, and 13 (10.31%) were effective in feilinjian peroral liquid group, with total significantly effective rate 68.25% and total effective rate 78.57%, both obviously higher than those in the control group(50.64% and 57.14% respectively). CONCLUSIONS: Feilinjian peroral liquid is significantly better than azithromycin in ameliorating self-conscious symptoms, symptoms scoring of patients with CT, Mh and UU infection, with little side-effects.

In vitro development of resistance to enrofloxacin, erythromycin, tylosin, tiamulin and oxytetracycline in Mycoplasma gallisepticum, Mycoplasma iowae and Mycoplasma synoviae.

The in vitro emergence of resistance to enrofloxacin, erythromycin, tylosin, tiamulin, and oxytetracycline in three avian Mycoplasma species, Mycoplasma gallisepticum, Mycoplasma synoviae and Mycoplasma iowae was studied. Mutants were selected stepwise and their MICs were determined after 10 passages in subinhibitory concentrations of antibiotic. High-level resistance to erythromycin and tylosin developed within 2-6 passages in the three Mycoplasma species. Resistance to enrofloxacin developed more gradually. No resistance to tiamulin or oxytetracycline could be evidenced in M. gallisepticum or M. synoviae after 10 passages whereas, resistant mutants were obtained with M. iowae. Cross-sensitivity tests performed on mutants demonstrated that mycoplasmas made resistant to tylosin were also resistant to erythromycin, whereas mutants made resistant to erythromycin were not always resistant to tylosin. Some M. iowae tiamulin-resistant mutants were also resistant to both macrolide antibiotics. Enrofloxacin and oxytetracycline did not induce any cross-resistance to the other antibiotics tested. These results show that Mycoplasma resistance to macrolides can be quickly selected in vitro, and thus, providing that similar results could be obtained under field conditions, that development of resistance to these antibiotics in vivo might also be a relatively frequent event.

Single dose oral azithromycin versus seven day doxycycline in the treatment of non-gonococcal mucopurulent endocervicitis.

The aim of this study was to compare single dose oral azithromycin versus seven-day doxycycline in the treatment of non-gonococcal mucopurulent cervicitis (MPC). One hundred and thirty-one women with non-gonococcal MPC were enrolled in a prospective-randomised study to compare the efficacy and safety of a single oral dose of 1 g azithromycin and a seven-day course of 100 mg doxycycline twice daily. Clinical examination and culture samples for Chlamydia trachomatis and other microorganisms were performed before and approximately 14 days after starting the treatment. Of the 131 women recruited (67 in the azithromycin group and 64 in the doxycycline group), Ureaplasma urealyticum was isolated from 21 (16%); Chlamydia trachomatis from 15 (11.5%); and Mycoplasma hominis from 3 (2.3%) of the patients at the initial examination. The eradication rate of baseline culture-positive cases at the follow-up visit in the azithromycin group was 71.4%, and 77.3% in the doxycycline group. There was no statistically significant difference in efficacy between the single dose azithromycin and seven-day course of doxycycline in the treatment of culture-positive cases. Azithromycin 1 g appears to be an effective and safe alternative to doxycycline for the treatment of non-gonococcal MPC.

A randomized, comparative study of the efficacy and tolerance of roxithromycin and doxycycline in the treatment of women with positive endocervical cultures for Chlamydia trachomatis and Mycoplasma spp. in an in vitro fertilization program.

A total of 45 patients wishing to enter an in vitro fertilization program had positive endocervical cultures for Chlamydia trachomatis, 86 had positive cultures for Ureaplasma urealyticum, and 11 had positive cultures for Mycoplasma hominis. These patients and their consorts were randomly allocated to treatment with either roxithromycin or doxycycline. Both antibiotics were completely effective against C. trachomatis. In patients with U. urealyticum infection, roxithromycin was successful in 73% and doxycycline in 87% of cases. Mycoplasma hominis was eradicated in 100% of cases by doxycycline and in 85% of cases by roxithromycin. Doxycycline caused significantly more side effects than did roxithromycin.

[Ureaplasma urealyticum--a new problem pathogen in neonatology]. / Ureaplasma urealyticum--ein neuer Problemkeim in der Neonatologie.

Some previous studies showed that Ureaplasma urealyticum is the most common germ that appears in the birthway of pregnant women and which is also frequently found in skin swabs and secretions of newborn and premature babies. The colonization of pregnant women by Ureaplasma urealyticum makes a premature birth more likely. Another factor of risk for a premature infant is a premature rupture of membranes for more than 24 hours which also makes an infection possible. There exists an association between pulmonary infection by Ureaplasma urealyticum and the development of a bronchopulmonary dysplasia especially for premature babies. According to our observations acute exacerbations of severe pneumonia can appear even after month. An attempt of therapy of pulmonary infection should be undertaken with erythromycin, if sensitive serotypes are present. In the case of erythromycin resistance chloramphenicol can be used but only under frequent controls of blood levels. We were able to observe rapid improvements with this effective therapy.

Perinatal mycoplasmal infections.

Maternal infections are known to play a major role in perinatal morbidity and mortality. Ureaplasma urealyticum and Mycoplasma hominis are sexually transmissible microorganisms associated with a number of pathologic conditions in the pregnant woman including chorioamnionitis and postpartum fever. They are rapidly gaining recognition as significant causes of perinatal infection, especially in infants born prematurely. This review summarizes current knowledge regarding the epidemiology, pathology, disease spectrum, and clinical manifestations of mycoplasmal and ureaplasmal perinatal infections and presents guidelines for proper diagnosis and treatment.

A randomized placebo-controlled trial of erythromycin for the treatment of Ureaplasma urealyticum to prevent premature delivery. The Vaginal Infections and Prematurity Study Group.

Ureaplasma urealyticum has been associated with low birth weight and histologic chorioamnionitis and it is a frequent isolate from the chorioamnion of patients who are delivered prematurely. In prior clinical trials using antibiotics active against U. urealyticum, antibiotic treatment was associated with reduced prematurity and increased mean birth weight. In this multicenter, randomized, double-blind clinical trial, pregnant women with U. urealyticum were treated with 333 mg of erythromycin base or placebo three times daily, starting between 26 and 30 weeks' gestation and continuing through 35 completed weeks of pregnancy. Women with urinary tract infection or Neisseria gonorrhoeae infection were excluded from the trial, and women with Chlamydia trachomatis or group B streptococci were excluded from these analyses. Erythromycin did not eliminate U. urealyticum from the lower genital tract. There were no significant differences between erythromycin- and placebo-treated women in infant birth weight or gestational age at delivery, in frequency of premature rupture of membranes, or in neonatal outcome.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women. Prevalence, risks and management at a South African infertility clinic.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms. We studied the wives in 40 consecutive infertile couples. Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs. M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs. Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal. DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis. One patient was lost to follow-up and excluded from the study. For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative. M hominis was isolated from 3 (7.5%) endocervical swabs. None of the endocervical swabs yielded a culture positive for U urealyticum. Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms. The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening. The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved. Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline.

[Combined etiological and pathogenetic therapy of urogenital Ureaplasma-Chlamydia-gonococcal infection in men]. / Kombinirovannaia étiologicheskaia i patogeneticheskaia terapiia urogenital'nykh ureaplazmenno-khlamidiino-gonokokkovykh infektsii u muzhchin.

One hundred and sixteen males with mixed Ureaplasma ++, chlamydial and gonorrheal urethritis were treated. 22 of them suffered from recent torpid urethritis and 94 were chronic patients including those with complications. The diagnosis was confirmed by the laboratory tests. The patients were subjected to complex treatment with immunostimulation (by the gonorrhea vaccine, methyluracil and pyrogenal), local therapy and the use of antibiotic combinations on day 8: gentamicin (0.84 g per treatment course) and doxycycline (2.1 g per treatment course). The treatment course was equal to 14 days. Favourable etiological and clinical results were observed in 114 patients. The recovery was confirmed by 3-fold verification. A high efficacy of the developed method studied clinically was stated.

[Infections by Mycoplasma hominis and Ureaplasma urealytycum in vaginal discharge. Incidence and treatment]. / Infections à Mycoplasmes hominis et Ureaplasma urealytycum dans les écoulements vaginaux. Fréquence et traitements.

This report summarizes the studies carried out on 100 patients who were examined for vaginal discharge. The following observations were made: Mycoplasma hominis in 13.59% of the cases, Ureaplasma urealytycum in 8.73% of the cases, that is, the presence of at least one of these microorganisms in 22.32 of the cases. All these infections were treated by tetracyclines administered in appropriate doses.

Ciprofloxacin compared with doxycycline for nongonococcal urethritis. Ineffectiveness against Chlamydia trachomatis due to relapsing infection.

We compared 7-day regimens of ciprofloxacin in dosages of 750 and 1000 mg twice daily with doxycycline 100 mg twice daily for the treatment of nongonococcal urethritis in 178 men enrolled in a prospective, randomized, double-blind trial. The overall clinical response was comparable in the three treatment groups at both 2 and 4 weeks after therapy. However, among patients who initially had cultures positive for chlamydia, Chlamydia trachomatis was reisolated within 4 weeks after treatment in none of 10 doxycycline-treated patients, in 11 (52%) of 21 patients treated with 750 mg of ciprofloxacin twice daily, and in six (38%) of 16 patients treated with 1000 mg of ciprofloxacin twice daily. Each of the recurrent strains was identical in serotype to the original infecting strain. We conclude that ciprofloxacin in dosages as high as 2 g daily is inadequate for treatment of chlamydial urethritis in men, often resulting in relapsing infections.

Evaluation of the significance of Mycoplasma hominis and Ureaplasma urealyticum in female genital tract infection--a retrospective case note study.

Routine screening for sexually transmitted diseases in new patients attending the Genitourinary Clinic in Stoke-on-Trent includes a culture for Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU). A retrospective study was carried out on 400 female patients to ascertain whether there were any significant differences between the group positive for MH and UU and the negative control group. The positive group were found to be younger on average, but to have similar sexual histories to the negative control group. An association was found between the presence of genital mycoplasmas and Gardnerella vaginalis. An odourous vaginal discharge was more common in the positive group. Erythromycin was ineffective in eradicating the organisms in 62.5% of patients with MH, and 70% of those with UU. Continuing work is required to identify those women in whom the presence of MH or UU could have pathogenic effects. Treatment regimens for this group of women need to be carefully reassessed, in the light of increasing antibiotic resistance.

Comparative evaluation of clindamycin versus clindamycin plus tobramycin in the treatment of acute pelvic inflammatory disease.

Fifty-one hospitalized women were treated with either clindamycin phosphate alone (N = 23) or a combination of clindamycin phosphate plus tobramycin (N = 28) for community-acquired pelvic inflammatory disease. The overall regimen clinical success rates were 100 and 91% for the clindamycin/tobramycin and clindamycin-alone groups, respectively. Efficacy for patients with positive pre-treatment Neisseria gonorrhoeae cultures was eight of eight (100%) for the clindamycin/tobramycin group and seven of eight (88%) in the clindamycin-alone group. Of the total population studied, 15 of 51 (29%) had positive pre-treatment cultures for Chlamydia trachomatis, and a microbiologic cure was attained in 15 of 15 (100%). However, in two of 15 (14.5%), the patient did not return for the 6-week culture, although the culture at discharge from the hospital was negative. No serious adverse reactions were observed, although oral follow-up treatment with clindamycin had to be discontinued in one patient because of diarrhea, which resolved without additional therapy. The results suggest that intravenous clindamycin alone is a viable alternative to the use of clindamycin/tobramycin for women with acute pelvic inflammatory disease requiring hospitalization.

[Experiences with oxytetracycline treatment of non-gonorrhea urethritis caused by Ureaplasma urealyticum]. / Erfahrungen mit der Oxytetrazyklin-Therapie der nicht-gonorrhoischen Urethritis durch Ureaplasma urealyticum.

In a retrospective study, the efficacy of tetracycline therapy was assessed in 48 men with non-gonococcal urethritis who only harbored Ureaplasma urealyticum in their urethras. After 2 weeks of therapy with 2.0 g oxytetracycline per day, U. urealyticum was still found in the urethra of 8 patients (17%). Urethritis was still present in 8 patients (17%) according to clinical criteria and in 11 patients (23%) according to microscopic findings. The persistence of U. urealyticum in the urethra did not correlate with the persistence of urethritis to a statistically significant degree. Therapy compliance, antibiotic resistance in a few cases, reinfections in 2 cases and a special host-parasite relationship are discussed with respect to the treatment failures.

Randomized comparison of ofloxacin and doxycycline for chlamydia and ureaplasma urethritis and cervicitis.

Fifty-eight males and 34 females with nongonococcal urethritis and/or cervicitis were treated to compare the efficacy and safety of 7-day regimens of oral ofloxacin 300 mg twice daily and doxycycline hyclate 100 mg twice daily. Forty-seven patients were randomized to receive ofloxacin and 45 patients to receive doxycycline. The microbiologic response rate was 97% (32/33) for both ofloxacin and doxycycline; the combined microbiologic and clinical cure rates were 98% for both treatment groups (ofloxacin 46/47, doxycycline 44/45). Ofloxacin was as effective as doxycycline in the treatment of chlamydial infections (96% vs. 100%). In patients with Ureaplasma urealyticum, the initial response was complete with either drug, but recurrence of infection was observed with both treatment groups (1 of 4 patients in the ofloxacin group and 2 of 11 patients in the doxycycline group). In the treatment of mixed Chlamydia trachomatis and U. urealyticum infections, all 5 patients treated with ofloxacin and 3 of 4 patients treated with doxycycline were cured. In symptomatic patients whose initial cultures were negative, clinical cures were complete with both drugs, but Ureaplasma was isolated at 3 or more weeks post-treatment in 2 patients treated with ofloxacin. In a study of single-dose ofloxacin treatment of uncomplicated gonorrhea, Neisseria gonorrhoeae was eradicated in all subjects, but C. trachomatis was not reliably eradicated. Both drugs were well tolerated with only minimal adverse effects reported in either treatment group. A multiple-dose regimen of ofloxacin appears to be a highly effective and well-tolerated alternative to doxycycline in nongonococcal sexually transmitted disease.

Azithromycin in the treatment of sexually transmitted disease.

One hundred and eighty-two patients were enrolled in a randomized third-party blinded study to assess the efficacy and safety of azithromycin in the treatment of sexually transmitted diseases. Three regimens of azithromycin, including a single oral dose, were compared with a standard treatment with doxycycline. The patients were followed for four weeks. Efficacy was evaluated in 168 patients (113 azithromycin, 55 doxycycline). Fourteen patients had negative cultures or did not come for all follow-up visits. Of the 168, 138 were infected with Chlamydia trachomatis, 43 with Neisseria gonorrhoeae, and 45 with Ureaplasma urealyticum. Ninety-six per cent of patients with chlamydial infections and 92% of those with gonorrhoea were cured with azithromycin. Two patients infected with N. gonorrhoeae, four with C. trachomatis and six with U. urealyticum had positive cultures on follow-up visits after receiving azithromycin. Of these 11 patients with positive cultures on follow-up visits, seven (five with U. urealyticum and two with C. trachomatis) violated the protocol by having intercourse with infected individuals during the study. Azithromycin was very well tolerated; one patient complained of mild abdominal pain shortly after receiving the drug, seven patients complained of mild nausea and two patients had mild diarrhoea.

Occurrence of Ureaplasma urealyticus and Mycoplasma hominis in non-gonococcal urethritis before and after treatment in a double-blind trial of ofloxacin versus erythromycin.

The efficacy of ofloxacin, a new quinolone derivate, was tested against that of erythromycin in a prospective double-blind trial in patients with non-gonococcal urethritis (NGU) with special reference to the occurrence of Mycoplasma hominis and Ureaplasma urealyticum. 188 male NGU patients were randomized to treatment with either ofloxacin 200 mg b.i.d. or erythromycin 500 mg b.i.d. for seven days. Before treatment eight (4.3%) patients, five in the erythromycin group and three in the ofloxacin group, were M. hominis positive. At follow-up day 8 and 15 after start of treatment all five in the erythromycin group and two in the ofloxacin group were still positive. U. urealyticum was recovered in 16 patients (8.5%) before treatment. One patient was still positive in the erythromycin group when examined day 15, whereas all patients were negative in the ofloxacin group at both follow-up controls. Clinically, the efficacy of treatment day 15 was 77.4% in the erythromycin group and 84.3% in the ofloxacin group. The difference was not significant. Side-effects occurred in 38.5% in the erythromycin group and in 21.3% in the ofloxacin group. This difference is significant. Ofloxacin is effective in the treatment of NGU in males and is an alternative to conventional antibiotic treatment.