In this episode, I’ll discuss outcomes with doxycycline vs azithromycin for community-acquired pneumonia.
Doxycycline is used as an alternative to azithromycin in combination with a beta-lactam to treat community-acquired pneumonia severe enough to be hospitalized. Reasons for avoiding azithromycin include allergy or concern about effects related to prolonged QTc intervals. However, doxycycline might not be as good an alternative to azithromycin as has been thought.
A group of authors has published a multicenter matched cohort study looking at the comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community-acquired pneumonia treated with beta-lactams. The analysis included over 8000 patients admitted to the hospital for community-acquired pneumonia and treated with either azithromycin or doxycycline in combination with a beta-lactam.
The authors found that in-hospital mortality was significantly lower in the azithromycin group than in the doxycycline group, with an odds ratio of 0.71. Additionally, 90-day mortality was also lower in the azithromycin group with a hazard ratio of 0.83. And finally, patients in the azithromycin group had an average of 1.37 more hospital-free days than those who received doxycycline.
The authors concluded:
Among hospitalized patients with community-acquired pneumonia, azithromycin was associated with a lower mortality and more hospital free days compared to doxycycline in combination with beta-lactams. Randomized controlled trials are needed to assess the effectiveness of each regimen and to compare their potential side effects.
While this is only a retrospective study, it should give clinicians the incentive to only switch away from azithromycin if there is a genuine need to avoid it.
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