{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:43:09Z","timestamp":1793090589195,"version":"4.5.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Community-acquired pneumonia (CAP) is a significant public health concern associated with increased rates of hospital admissions and mortality. The purpose of the current study was to compare beta-lactam plus azithromycin or doxycycline vs fluoroquinolones in adults hospitalized with CAP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched several databases from inception to 10 June 2024. Two reviewers independently screened, selected, and extracted data. Disagreements were resolved by consensus or a third reviewer. Study quality was assessed in duplicate with the Cochrane Risk of Bias 2 for randomized studies and the Newcastle-Ottawa Scale for nonrandomized studies. Meta-analysis was conducted by a random effect model when feasible. Network meta-analysis was performed to compare direct and indirect evidence. The GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation) was followed to rate the certainty of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty studies were included (20 beta-lactam + azithromycin, 7 beta-lactam + doxycycline, 12 levofloxacin, and 4 moxifloxacin): 6 were randomized, enrolling 861 participants (mean age, 61.8 years; 43.2% women), and 14 were nonrandomized, enrolling 185 928 participants (mean age, 65.2 years; 42.9% women). Direct comparison and network meta-analysis results showed no statistically significant differences and likely equal effectiveness between beta-lactam + azithromycin and beta-lactam + doxycycline in terms of in-hospital mortality, need for intensive care unit admission or invasive mechanical ventilation, or safety outcomes including Clostridioides difficile infection and QT prolongation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The current evidence demonstrated no likely difference in outcomes between azithromycin and doxycycline in adults hospitalized with CAP receiving beta-lactam. Head-to-head randomized clinical trials are needed to validate these results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag253","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:01:50Z","timestamp":1777593710000},"source":"Crossref","is-referenced-by-count":2,"title":["Beta-Lactam Plus Azithromycin or Doxycycline vs Fluoroquinolones in Adult Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Network Meta-analysis"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9700-737X","authenticated-orcid":false,"given":"Magdoleen H","family":"Farah","sequence":"first","affiliation":[{"name":"Evidence-Based Practice Research Program, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3326-301X","authenticated-orcid":false,"given":"Mohamed","family":"Abusalih","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Research Program, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2886-341X","authenticated-orcid":false,"given":"Wigdan","family":"Farah","sequence":"additional","affiliation":[{"name":"Division of Pulmonology and Critical Care Medicine, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4244-9204","authenticated-orcid":false,"given":"Mohamad","family":"El Labban","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mayo Clinic Health System , Mankato, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qusay","family":"Haydour","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University , Indianapolis, Indiana ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8357-0343","authenticated-orcid":false,"given":"Neha","family":"Ramachandran","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Research Program, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Research Program, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin F","family":"Barreto","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Prokop","sequence":"additional","affiliation":[{"name":"Mayo Clinic Libraries, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Hassan","family":"Murad","sequence":"additional","affiliation":[{"name":"Evidence-Based Practice Research Program, Mayo Clinic , Rochester, Minnesota ,","place":["USA"]},{"name":"Robert D. and Patricia E. 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