Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2026
Doxycycline in the treatment of outpatient mild community-acquired pneumonia: a propensity-matched retrospective cohort study.
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Drozdinsky Genady, Ness Asaf, Shahar Melanie, Kushnir Shiri, Bishara Jihad, Eliakim-Raz Noa
Аннотация
OBJECTIVES: Community-acquired pneumonia (CAP) is a leading cause of healthcare visits. Choosing an empiric antibiotic is challenging because the aetiology often remains unknown. This study aimed to examine the effectiveness of doxycycline for outpatient CAP compared with other antibiotics.
METHODS: This propensity-matched (1:4) retrospective cohort study used data from Clalit Health Services, a national health service in Israel. The study included adult patients without risk factors who had a diagnosis of CAP and were treated as outpatients with monotherapy between 2013 and 2023. The cohort was followed for 30 days, and the primary outcome was a 14-day regimen switch. Secondary outcomes included 30-day hospitalization and 30-day mortality. Cox regression was used to compute hazard rates (HRs) with 95% CIs.
RESULTS: A total of 108 017 patients with CAP were identified. Among these, 13 495 patients treated with doxycycline were matched with 53 980 individuals treated with other antibiotics. The most commonly prescribed antibiotics in the control group were roxithromycin (34%), cefuroxime (32%), and amoxicillin/clavulanate (21%). Risk of switching antibiotics within 14 days was lower in the doxycycline group compared with all other antibiotics (5.6% vs. 7.8%) yielding an HR of 0.71 (95% CI, 0.65-0.76). Results remained significant in comparison with each individual antibiotic except azithromycin (5.8%), which was comparable with doxycycline. There was fewer hospitalization in the doxycycline group (2.9% vs. 3.4%) yielding an HR of 0.85 (95% CI, 0.77-0.95). There was also no significant difference in 30-day mortality (0.1% vs. 0.2%) with an HR of 0.6 (95% CI, 0.32-1.13) in the multivariable analysis.
CONCLUSIONS: The findings of this study support the potential noninferiority of empiric doxycycline compared with other alternatives for outpatient mild CAP.
METHODS: This propensity-matched (1:4) retrospective cohort study used data from Clalit Health Services, a national health service in Israel. The study included adult patients without risk factors who had a diagnosis of CAP and were treated as outpatients with monotherapy between 2013 and 2023. The cohort was followed for 30 days, and the primary outcome was a 14-day regimen switch. Secondary outcomes included 30-day hospitalization and 30-day mortality. Cox regression was used to compute hazard rates (HRs) with 95% CIs.
RESULTS: A total of 108 017 patients with CAP were identified. Among these, 13 495 patients treated with doxycycline were matched with 53 980 individuals treated with other antibiotics. The most commonly prescribed antibiotics in the control group were roxithromycin (34%), cefuroxime (32%), and amoxicillin/clavulanate (21%). Risk of switching antibiotics within 14 days was lower in the doxycycline group compared with all other antibiotics (5.6% vs. 7.8%) yielding an HR of 0.71 (95% CI, 0.65-0.76). Results remained significant in comparison with each individual antibiotic except azithromycin (5.8%), which was comparable with doxycycline. There was fewer hospitalization in the doxycycline group (2.9% vs. 3.4%) yielding an HR of 0.85 (95% CI, 0.77-0.95). There was also no significant difference in 30-day mortality (0.1% vs. 0.2%) with an HR of 0.6 (95% CI, 0.32-1.13) in the multivariable analysis.
CONCLUSIONS: The findings of this study support the potential noninferiority of empiric doxycycline compared with other alternatives for outpatient mild CAP.