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Comparative analysis of clarithromycin and doxycycline efflcacy and tolerability in the treatment of urethral syndrome caused by Ureaplasma urealyticum

Introduction: Ureaplasma urealyticum are species in the family Mycoplasmataceae and these microorganism can be found commensal in lower genitourinary tract of sexually active people. Moreover, U. urealyticum have been associated with various clinical conditions such as NGU, postpartum fever, infertililty, and PID. Aim: the aim of present study was to compare the efficacy and tolerance of clarithromycin versus doxycycline in the treatment urethral syndrome caused by Ureaplasma urealyticum in nonpregnant females over 18 years of age at the County Hospital Požega. Methods and patients: In period from 2005 to 2006. at the County Hospital Požega was conducted prospective, randomised, comparative and open study on 72 nonpregnant female outpatients >18 years age with the diagnosis of urethral syndrome was diagnosed by the presence of at least two symptoms lasting for 3 weeks or longer: dysuria, pollakiuria, urgency, nocturia, more than 10 WBC on each high power microscope field in urine sediment. Ureaplasma urealyticum was isolated from urethral/endocervical swab as a pathogen in ali cases (colony number found to be more than 104 per ml).Urine culture was bacteriologically negative and concomitants- Gonococcal, T. vaginalis, C. trachomatis, C. albicans infections were excluded. Laboratory analysis of urine and urethral/endocervical swab were performed at the Department of Microbiology, County Hospital Požega. Mycoplasma IST 2 (BioMerieux ) semiquantitative culturing test vvasused for the isolations and evaluations in vitro antimicrobial susceptibilities of U. urealyticum to doxycycline, ofloxacin, josamycin, erythromycin, tetracycline, ciprofloxacin, azithromycin, clarithromycin and pristinamycin. A total of 72 patients, 40 patients (control group) treated with doxycycline in a dose of lOOmg b.i.d. for 14 days, and other 32 patients treated with clarithromycin in a dose of 500 mg b.i.d. for 14 days.TTie same therapy was applied in patients partners at the same time and adverse events were registrated. Clinical efficacy, tolerability and adverse events of the administered drugs were evaluated at theend and 4weeks after completion therapy and bacteriological efficacy was evaluated 4 weeks after therapy and defined as eradication or persistence Statistical method: T- test of independent samples with level od significance less than 5%(p<0, 005) was used. Results: In period from 2005 to 2006 , a total of 72 female patients with urethral syndrome caused by Ureaplasma urealyticum were examined at the County Hospital Požega. The age range of patients was 18- 54 year, median M = 33 year, X= 33, 60 ±8, 99. In the doxycycline group age range was 18-49 years, M=31, X=32, 33±9, 08 and in the clarithromycin group age range was 21-54 year, M=35, X=35, l±8, 77. Bacteriological eradications, based on negative assay, occured in 95% (40/38 patients) doxycycline -treated patients and 91% (32/29 patients) clarithromycin -treated patients, (P=0, 04, -0, 12<P1-P2<0, 11). Clinical curerates in the doxycycline group was 93% (cure- 37, improvement- 2, failure-1 patient) and in the clarithromycin group was 90% (cure -28, improvement -3, failure-1 patient). The efficacy difference for bacteriological response (eradication) betvveen doxycycline and clarithromycin were not statistically significant. Clinical cure did not significantly differ with regard to the administered doxycycline or clarithromycin. Resistance rates of U. urealyticum was : doxycycline 0%, josamycin 1, 3 %, ofloxacin 38%, erythromycin 9, 7%, tetracycline 0%, ciprofloxacin 59, 7%, azithromycin 13%, clarithromycin 6, 3% and pristinamycin 1, 3 %. Frequency of adverse events : in doxycyclin group 18 % patients had gastrointestinal adverse events included diarrhea, abdominal pain, nausea, dyspepsia, and in clarithromycin group detected averse events in 15% cases (headache, tinnitus, nausea, dyspepsia) Conclusion: This study showed that clarithromycin and doxycycline are equally efficacions in treatment urethral syndrome caused by Ureaplasma urealyticum and have similar tolerability. No difference in adverse event rates was found In the evaluation of antibiotics susceptibilty in vitro, higher resistance was obtained against quinolons- ciprofloxacin and ofloxacin, resistance against josamycin, pristinamycin, clarithromycin was low, and on the increase at erythromycin and azithromycin and there was no resistance against doxycycline and tetracycline.

Ureaplasma urealyticum ; urethral syndrome ; doxycycline ; clarithromycin

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