Doxycycline vs. macrolides in combination with a [beta]-lactam antibiotic for the treatment of community-acquired pneumonia in inpatients

Background Hospitalized patients with non-severe community-acquired pneumonia (CAP) are treated with a [beta]-lactam plus either a macrolide or doxycycline. Limited data exist on the effectiveness of the latter combination. Therefore, we aimed to compare the combination of doxycycline vs. macrolide...

Full description

Saved in:
Bibliographic Details
Published in:European journal of medical research 2022-12, Vol.27 (1)
Main Authors: Aldhahri, Raghad K, Gabb, Shahad G, Shoaib, Ohoud A, Almadani, Reem M, Eljaaly, Khalid, Thabit, Abrar K
Format: Article
Language:English
Subjects:
Analysis
Beta lactamases
Doxycycline
Hospital patients
Methicillin
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Hospitalized patients with non-severe community-acquired pneumonia (CAP) are treated with a [beta]-lactam plus either a macrolide or doxycycline. Limited data exist on the effectiveness of the latter combination. Therefore, we aimed to compare the combination of doxycycline vs. macrolide when either is combined with a [beta]-lactam from effectiveness and safety perspectives. Methods This was a retrospective cohort study in CAP inpatients between December 2013 and November 2020. Patients were divided into BL-D ([beta]-lactam plus doxycycline) and BL-M ([beta]-lactam plus a macrolide [azithromycin or clarithromycin]) groups. The primary endpoint was time to clinical stability. Secondary endpoints included length of stay (LOS) and in-hospital mortality. Results Of 197 patients included, 57 were in the BL-D arm and 140 were in the BL-M arm. Patients were similar at baseline, except for the presence of leukocytosis, risk factors for drug resistance, and duration of therapy (P < 0.05 for all comparisons). No difference in clinical cure rate was observed (94.7% vs. 91.4%; P = 0.43). Time to clinical stability and LOS were similar in both groups at 4 (P = 0.82) and 7 days (P = 0.62), respectively. While only three patients died, only one (from the BL-M group) was due to sepsis. Liver enzymes elevation was more prominent in the BL-M group (21.4% vs. 5.3%; P = 0.01). A subgroup analysis showed shorter time to clinical stability with clarithromycin but higher cure rates with azithromycin. Conclusions Data on doxycycline use with a [beta]-lactam are scarce. Our study showed that such regimen was comparable in effectiveness to regimens involving macrolides with a better safety profile. Keywords: Community-acquired pneumonia, Doxycycline, Macrolides, Azithromycin, Clarithromycin
ISSN:0949-2321
DOI:10.1186/s40001-022-00912-8