MIAMI (AFP) — Two-time Miami Open champion Andy Murray fought back for a 4-6, 6-3, 6-4 win over struggling Italian Matteo Berrettini in the first round at Hard Rock Stadium on Wednesday.

Berrettini needed medical attention near the end of the second set after appearing to almost faint on court but he battled on.

The Italian recently returned to the tour after an injury-plagued 2023, reaching the final of a Challenger event in Phoenix.

He broke Murray's serve in the first game of the match and was in firm control of the opening set.

But he faded badly in the second and called a medical time-out when 5-2 down after walking off the court looking dizzy.

The weather in Miami was not particularly hot or humid and more pleasantly mild than has often been the case at the tournament in past years.

The 27-year-old former world No. 6, put up a better fight in the third, but a solid-looking Murray saw the match out in two hours and 47 minutes.

Murray made just 20 unforced errors while Berrettini committed 44, as the Scot clinched his fourth consecutive first-round win.

"There is life in the old dog yet," wrote Murray on the television camera lens at the end of the game and he was pleased with the manner of his win.

"I started off a little bit slow, but I do think I played pretty well from the middle of the first set until the end of the match."

"I created a lot of opportunities and he was struggling for a little bit at the end of the second and beginning of the third. I capitalized on that and got off to a quick start in the third. I served it out well in the end."

Murray, who won the Miami Open in 2009 and 2013, will meet 29th-seeded Argentine Tomas Martin Etcheverry in the next round.

In the WTA event, American Sloane Stephens beat Angelique Kerber 6-2, 6-3 in a meeting of two former grand slam champions.

Stephens, celebrating her 31st birthday, was on top throughout against the German who had shown good form in Indian Wells where she reached the fourth round.

Stephens, the 2018 Miami champion, will play Romania's 19th-seeded Sorana Cirstea in the second round.

Four-time grand slam-winner Naomi Osaka had little trouble in defeating Italy's Elisabetta Cocciaretto 6-3, 6-4 in one hour, 18 minutes to move into the second round.

Osaka is ranked 229th in the world after taking a break after having a child and spending over a year out of the game and is returning to the scene of her run to the final in 2022 where lost to Iga Swiatek in the final.