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Should We Use Plain Old Doxycycline for Pneumonia?

September 13, 2022

Written by Gabby Leonard

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Doxycycline is an accessible and effective option to treat both typical and atypical bacteria that may cause community acquired pneumonia (CAP).

Why does this matter?
CAP is the #1 cause of death and morbidity for communicable diseases, and increasing antimicrobial resistance has disrupted available antimicrobial therapies. Would an old standby drug still work?

Maybe it’s magic. Maybe it’s doxycycline.
This meta-analysis looked at six randomized controlled trials involving 834 adults that compared treatment of CAP with doxycycline versus alternative antibiotic agents (macrolides and fluoroquinolones) to evaluate clinical cure rate.

Clinical cure rate (CCR) was defined as resolution of clinical signs/symptoms at the end of treatment, or follow-up without new symptoms, complications or need for further therapy. CCR was similar between doxycycline and other groups (87.2% vs. 82.6%, OR 1.29, 95%CI 1.15-3.21; P = 0.01), with comparable adverse event rates. Secondary outcomes showed significantly lower length of hospitalization in patients who received doxycycline vs. levofloxacin (4.0 +/-1.8 days vs. 5.7 +/- 2.1 days, p <0.001). Additionally, doxycycline was significantly lower in cost ($64 USD +/- 24.4 doxycycline vs. $122.1 +/- 15.8 levofloxacin, P <0.001).

With increased resistance to macrolides and B-lactams, doxycycline may be a front-runner for treatment of CAP given its efficacy, low cost, and low side-effect profile.

It should be noted that there are growing concerns about pneumococcal resistance to doxycycline and tetracycline, specifically in areas with high penicillin resistance. These RCTs were conducted prior to 2005, and resistance has changed for the worse since that time. Additionally, they did not analyze combination therapies for CAP. Given this, there is certainly opportunity for studies around single and dual-drug treatment for CAP with tetracyclines.

Efficacy of Doxycycline for Mild-to-moderate Community-acquired Pneumonia in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Infect Dis. 2022 Jul 29;ciac615. doi: 10.1093/cid/ciac615. Online ahead of print.

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