5MinuteConsult Journal Club

Doxycycline for Non-Severe Community Acquired Pneumonia

Reference

Clinical Infectious Diseases, ciac615, https://doi.org/10.1093/cid/ciac615

Study Summary

Systematic review of 6 randomized controlled trials comparing doxycycline to macrolides and fluroquinolones. The clinical cure rates were doxycycline: 87.2% vs other drugs 82.6%; (OR = 1.29; CI 0.73-2.28). When restricted to those studies with the lowest risk of bias, there was a significant benefit to doxycycline over the other anti-microbials: 87.1% vs 77.8% (OR = 1.92; CI 1.15-3.21). Adverse events rates were comparable.

Conclusions

For non-severe community acquired pneumonia, doxycycline is as effective (maybe more effective) than macrolides or fluroquinolones.

Discussion

It always impresses me when patients ask for a “Z-pak”. I often respond “Why, do you think you have chlamydia?” OK, no, I just think that.

This is clear, doxycycline should be the drug of choice. No need to add a second agent. For a patient with severe pneumonia, calculate a severity score, and treat accordingly.

And for those asking for the “Z-pak”, I do tell them that azithromycin is not indicated first line most anything, not even chlamydia. Not for sinusitis, pharyngitis, or pneumonia. For patients with COPD, maybe for acute exacerbations and for prevention. Azithromycin resistance is not a patient problem, it is an over-prescription problem. Our problem.

Our job is to treat patients with the best evidence…. It is not to make them happy.

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