{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T20:49:35Z","timestamp":1789764575081,"version":"4.0.1"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T00:00:00Z","timestamp":1696896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Community-acquired pneumonia (CAP) is a significant source of hospital admissions and mortality. Atypical organisms are implicated in up to 40% of cases of CAP diagnoses. We studied the difference in outcomes of severe CAP patients treated with doxycycline versus azithromycin in addition to \u03b2-lactam therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>This was a prospective observational cohort study from March 2020 to July 2022 in a medical ICU (MICU) of an academic quaternary medical center. Adults \u226518\u2005years admitted to the MICU receiving doxycycline or azithromycin in addition to \u03b2-lactam therapy for the treatment of CAP were included for analysis. The primary outcomes were in-hospital and 30\u2005day mortality. Secondary outcomes were ICU and hospital length-of-stay, 30\u2005day readmission, days of mechanical ventilation, escalation and duration of antibiotics, adverse effects such as Clostridioides difficile infection and QTc prolongation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-three patients were in the azithromycin group and eighty-six patients in the doxycycline group. Both groups had similar APACHE IV and CURB-65 scores. The mean Charlson Comorbidity Index score was higher for the doxycycline group compared with the azithromycin group (P\u200a=\u200a0.04). There was no statistically significant difference in in-hospital and 30\u2005day mortality between the groups (P\u200a=\u200a0.53, P\u200a=\u200a0.57). There were no significant differences in any of the secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MICU patients with severe CAP who received doxycycline versus azithromycin in addition to \u03b2-lactam treatment showed no significant differences in outcomes. These data offer support for inclusion of doxycycline as an alternative regimen in current IDSA recommendations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkad301","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T16:09:34Z","timestamp":1695139774000},"page":"2816-2823","source":"Crossref","is-referenced-by-count":8,"title":["\u03b2-Lactams plus doxycycline versus azithromycin for treatment of severe community-acquired pneumonia in critically ill patients"],"prefix":"10.1093","volume":"78","author":[{"given":"Alexandra","family":"Greco Kinney","sequence":"first","affiliation":[{"name":"Department of Pharmacy, WVU Medicine , Morgantown, WV , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Kovacic Scherrer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, WVU Medicine , Morgantown, WV , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sauradeep","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, West Virginia University , Morgantown, WV , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranav","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Pittsburgh Medical Center , Pittsburgh, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijin","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, West Virginia University , Morgantown, WV , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hadique","sequence":"additional","affiliation":[{"name":"Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, West Virginia University , Morgantown, WV , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,10]]},"reference":[{"key":"2023120106060618200_dkad301-B1","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1007\/s12325-020-01248-7","article-title":"Burden of community-acquired pneumonia and unmet clinical needs","volume":"37","author":"Ferreira-Coimbra","year":"2020","journal-title":"Adv Ther"},{"key":"2023120106060618200_dkad301-B2","first-page":"1","article-title":"Deaths: final data for 2013. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics","volume":"64","author":"Xu","year":"2016","journal-title":"National Vital Stat Syst"},{"key":"2023120106060618200_dkad301-B3","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1086\/511159","article-title":"Infectious Diseases Society of America\/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults","volume":"44","author":"Mandell","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2023120106060618200_dkad301-B4","first-page":"1","article-title":"ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of severe community-acquired pneumonia","volume":"61","author":"Martin-Leoches","year":"2023","journal-title":"Eur Respir J"},{"key":"2023120106060618200_dkad301-B5","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1093\/cid\/cix647","article-title":"Adults hospitalized with pneumonia in the United States: incidence, epidemiology, and mortality","volume":"65","author":"Ramirez","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2023120106060618200_dkad301-B6","first-page":"1699","article-title":"Atypical pathogens and challenges in community-acquired pneumonia","volume":"69","author":"Thibodeau","year":"2004","journal-title":"Am Fam Physician"},{"key":"2023120106060618200_dkad301-B7","first-page":"1","article-title":"Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis","volume":"13","author":"Wang","year":"2023","journal-title":"BMJ Open"},{"key":"2023120106060618200_dkad301-B8","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2023120106060618200_dkad301-B9","doi-asserted-by":"crossref","first-page":"S579","DOI":"10.1093\/ofid\/ofx163.1513","article-title":"Retrospective cohort study of the efficacy of azithromycin versus doxycycline as part of combination therapy in non-intensive care unit veterans hospitalized with community-acquired pneumonia","volume":"4","author":"Spivey","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2023120106060618200_dkad301-B10","doi-asserted-by":"crossref","first-page":"E71","DOI":"10.1111\/j.1469-0691.2011.03759.x","article-title":"Doxycycline versus macrolides in combination therapy for treatment of community-acquired pneumonia","volume":"18","author":"Teh","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"2023120106060618200_dkad301-B11","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/j.chest.2020.03.051","article-title":"The burden of community-acquired pneumonia requiring admission to ICU in the United States","volume":"158","author":"Cavallazzi","year":"2020","journal-title":"Chest"},{"key":"2023120106060618200_dkad301-B12","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.rmed.2015.04.007","article-title":"Outcomes in patients with community-acquired pneumonia admitted to the intensive care unit","volume":"109","author":"Cavallazzi","year":"2015","journal-title":"Respir Med"},{"key":"2023120106060618200_dkad301-B13","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/CCM.0b013e3182a66b9b","article-title":"Macrolides and mortality in critically ill patients with community-acquired pneumonia: a systematic review and meta-analysis","volume":"42","author":"Sligl","year":"2014","journal-title":"Crit Care Med"},{"key":"2023120106060618200_dkad301-B14","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1093\/cid\/cis414","article-title":"Macrolide-based regimens and mortality in hospitalized patients with community- acquired pneumonia: a systematic review and meta-analysis","volume":"55","author":"Asadi","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2023120106060618200_dkad301-B15","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1001\/archinte.159.3.266","article-title":"Doxycycline is a cost-effective therapy for hospitalized patients with community-acquired pneumonia","volume":"159","author":"Ailani","year":"1999","journal-title":"Arch Intern Med"},{"key":"2023120106060618200_dkad301-B16","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/cid\/ciab863","article-title":"Effectiveness of beta-lactam plus doxycycline for patients hospitalized with community-acquired pneumonia","volume":"75","author":"Uddin","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2023120106060618200_dkad301-B17","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/jhm.8","article-title":"Effectiveness of ceftriaxone plus doxycycline in the treatment of patients hospitalized with community-acquired pneumonia","volume":"1","author":"Flanders","year":"2006","journal-title":"J Hosp Med"},{"key":"2023120106060618200_dkad301-B18","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1093\/cid\/ciac615","article-title":"Efficacy of doxycycline for mild-to-moderate community-acquired pneumonia in adults: a systematic review and meta-analysis of randomized controlled trials","volume":"76","author":"Choi","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2023120106060618200_dkad301-B19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/microorganisms10122326","article-title":"Atypical pathogens in adult community-acquired pneumonia and implications for empiric antibiotic treatment: a narrative review","volume":"10","author":"Garin","year":"2022","journal-title":"Microorganisms"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/78\/12\/2816\/53850457\/dkad301.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/78\/12\/2816\/53850457\/dkad301.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T01:06:54Z","timestamp":1701392814000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/78\/12\/2816\/7303696"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,10]]},"references-count":19,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,10,10]]},"published-print":{"date-parts":[[2023,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkad301","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,12]]},"published":{"date-parts":[[2023,10,10]]}}}