Doxycycline Versus Azithromycin for the Treatment of Community-Acquired Pneumonia in Adults: A Multi-Centre Randomised Controlled Trial

Author(s):Dr. Y Mandaviya

Received: 2019-08-01 Accepted: 2019-08-25 Published: 2019-09-27

Abstract

Background: Community-acquired pneumonia (CAP) is a leading cause of infection-related morbidity and mortality. Optimal antibiotic selection between doxycycline and azithromycin for mild-to-moderate CAP in ambulatory patients remains debated.
Objective: To compare clinical cure rates, time to symptom resolution, and adverse effects of doxycycline versus azithromycin in outpatient adults with mild-to-moderate CAP.
Methods: A double-blind, randomised controlled trial enrolled 740 adults with CAP (PSI Class I–III) across 22 primary care and emergency department sites. Participants received doxycycline 100 mg twice daily for 7 days or azithromycin 500 mg on day 1 then 250 mg daily for 4 days.
Results: Clinical cure at day 14 was achieved in 84.3% of doxycycline recipients versus 81.1% of azithromycin recipients (difference 3.2%; 95% CI –1.9 to 8.3%; p=0.22). Median time to symptom resolution was 5 days in both arms. Gastrointestinal adverse events were more frequent with azithromycin (23.8% vs 14.6%; p=0.001).
Conclusion: Doxycycline and azithromycin demonstrate comparable clinical cure rates for outpatient CAP. Doxycycline may be preferred given its lower rate of gastrointestinal adverse effects and rising macrolide resistance.

Keywords: Doxycycline Versus, Community-Acquired, Adults

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