Azithromycin vs. Doxycycline for CAP in Hospitalized Patients
Yewande Odeyemi et al.
Clinical Infectious Diseases, May 16, 2025 (Online ahead of print)
[DOI: 10.1093/cid/ciaf252]
🩺 Clinical Implications for the ED:
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For admitted CAP patients receiving a beta-lactam, consider:
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Azithromycin > Doxycycline for mortality benefit and shorter hospital stays.
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These results may inform empiric antibiotic choice when admitting from the ED.
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Highlights the need for prospective RCTs, but supports current IDSA guidelines favoring azithromycin in certain settings.
🧪 Study Design:
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Multicenter matched cohort study at Mayo Clinic hospitals (May 2018–Sept 2022).
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Included patients hospitalized with community-acquired pneumonia (CAP) treated with:
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Azithromycin + beta-lactam or
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Doxycycline + beta-lactam
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Excluded: Patients on both antibiotics or on either chronically prior to admission.
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Patients were matched 1:1 based on CHF, CAD, COPD, HIV, immunosuppression, and PSI class.
📊 Key Results:
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Matched cohort size: 2671 patients per group.
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In-hospital mortality:
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Lower with azithromycin (OR 0.71; 95% CI: 0.56–0.90)
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90-day mortality:
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Also lower with azithromycin (HR 0.83; 95% CI: 0.73–0.95)
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Hospital-free days:
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More in azithromycin group (+1.37 days; 95% CI: 0.99–1.74)
Odeyemi, Y., Tekin, A., Schanz, C., Schreier, D., Cole, K., Gajic, O. and Barreto, E., 2025. Comparative effectiveness of azithromycin versus doxycycline in hospitalized patients with community acquired pneumonia treated with beta-lactams: A multicenter matched cohort study. Clinical Infectious Diseases, p.ciaf252.