Combination of Oral Doxycycline and Rifampin for Pan-Drug Resistant Klebsiella pneumoniae Infection: A Case Report.

Pan-drug resistant Klebsiella pneumoniae is a major therapeutic challenge, particularly when standard last-line agents are unavailable or contraindicated. We report a 45-year-old man with multifocal osteomyelitis and persistent purulent wound discharge despite broad-spectrum antibiotics, repeated debridement, and two sequential amputations. Wound culture grew K. pneumoniae resistant to all antibiotics tested in the locally available susceptibility panel. Initial treatment with colistin plus extended-infusion meropenem was discontinued because of acute kidney injury. Oral doxycycline 100 mg twice daily combined with rifampin 600 mg once daily was then initiated as salvage therapy, resulting in rapid resolution of purulent discharge and marked reduction in inflammatory markers. This case suggests that oral doxycycline plus rifampin may represent a low-cost and accessible salvage option for highly resistant K. pneumoniae infections when standard therapies are unavailable or not tolerated.