Doxycycline for the treatment of community-acquired pneumonia

This article is from the NEJM Journal Watch

Doxycycline for Community-Acquired Pneumonia

Doxycycline for the treatment of community-acquired pneumonia

Review by Abigail Zuger, MD

Meta-analyses showed that the cure rate of doxycycline was comparable
to that of macrolides and quinolones.

Doxycycline is often the last resort
for the treatment of community-acquired pneumonia (CAP).

The latest U.
S.
guidelines do list doxycycline as a treatment option for outpatient CAP, but it is a conditional recommendation with "low quality of evidence" (NEJM JW Gen Med Dec 1 2019 and Am J Respir Crit Care Med 2019; 200:45), British guidelines have a similar
attitude towards doxycycline.

However, as resistance rates of β-lactams and macrolides climb, tetracyclines are gaining renewed attention
.

The person lived alone in the residence for 4 days and left the house
15 days before the environmental sample.

Testing of non-porous surfaces (doorknobs, bathrooms, and kitchen units) and porous surfaces (bedding, clothing) revealed monkeypox virus DNA and live monkeypox virus
.

The same amount of viral DNA was found on porous and porous contaminated products, but the proportion of live viruses found on porous contaminated products (60%) was higher than that on nonporous contaminated products (5%)
.

The researchers conducted a meta-analysis of six randomized clinical trials conducted between 1984 and 2004 that compared the use of doxycycline and other drugs to treat CAP
.

In a total of 834 outpatient and inpatient adult patients (none of whom were required to be in intensive care), various intravenous or oral doxycycline regimens achieved clinical cure rates of nearly 90%, similar
to those in the control group (3 macrolides, 3 fluoroquinolones).

Outcomes including length of hospital stay, cost of treatment, and adverse events were similar
.

None of the trials included microbiological and resistance data
.

Doxycycline has good pharmacokinetic profiles, as well as good activity
for most respiratory pathogens.

However, as one commentator pointed out, sorting out the pros and cons of medication is a complex task
.

On the one hand, tetracycline resistance mutations may be widespread in the community (decades ago, 30% of pneumococcal strains in the United States were resistant
).

On the other hand, in this meta-analysis and several relatively new studies, the clinical performance of doxycycline was excellent
.

In addition, the use of the drug appears to have a very low risk of Clostridium difficile infection, in addition to which it may also have anti-inflammatory properties
.

Finally, when considering the use of doxycycline, clinicians are best known for local resistance patterns
.

Commented on the article

Choi SH et al.

Musher DM.