The usage of doxycycline might assist shield in opposition to Clostridioides difficile (C. diff) an infection for some sufferers with pneumonia, in keeping with a brand new research printed within the American Journal of An infection Management.
Particularly, research authors discovered that for hospitalized sufferers with community-acquired pneumonia who had skilled C. diff infections within the prior 12 months, using doxycycline, as a substitute of the extra generally used azithromycin, lowered the event of latest C. diff infections by 45%.
Typically acquired by hospitalized sufferers taking broad-spectrum antibiotics, C. diff infections may be lethal. There are greater than 450,000 C. diff infections within the US annually, resulting in as many as 30,000 deaths, in keeping with public well being estimates. These infections additionally confer a excessive threat of recurrence; greater than a 3rd of sufferers who’ve a C. diff an infection will go on to have one other sooner or later.
As a result of pneumonia is so frequent and is often handled with broad-spectrum antibiotics, hospitalized sufferers with pneumonia are at elevated threat of creating a C. diff an infection.
For sufferers who’re admitted to a hospital with pneumonia, medical pointers usually advocate using azithromycin, which penetrates the lung tissue and may efficiently deal with Legionella pneumonia in addition to extra frequent varieties of pneumonia. Whereas doxycycline shouldn’t be used to deal with Legionella pneumonia, it may be efficient in opposition to different varieties of pneumonia.
As well as, doxycycline has optimum absorption within the higher gastrointestinal tract with minimal impression on the intestine microbiome, which might account for the lowered threat of C. diff an infection.
On this retrospective research, researchers analyzed outcomes of 156,107 sufferers handled for pneumonia in Veterans Affairs Hospitals between January 2009 and August 2022. For inclusion within the evaluation, sufferers needed to be admitted to the hospital not more than 48 hours earlier than a pneumonia analysis to make sure that all circumstances have been thought of community-acquired pneumonia.
Sufferers identified with Legionella pneumonia or viral pneumonia have been excluded from the research as a result of the really useful remedy for these situations is completely different than that for typical community-acquired pneumonia. Any affected person who was identified with a C. diff an infection inside 30 days of antibiotic remedy was presumed to have antibiotic-associated C. diff.
As anticipated, primarily based on medical pointers, most sufferers have been handled with azithromycin (87%) whereas a small proportion obtained doxycycline (13%). Total, lower than 1% of sufferers developed C. diff infections, however amongst sufferers who had skilled a C. diff an infection within the 12 months earlier than their pneumonia analysis, 12% developed a brand new C. diff an infection related to the antibiotic remedy.
Amongst sufferers with no historical past of C. diff infections, there was no statistical distinction within the charge of C. diff infections between those that obtained azithromycin and those that obtained doxycycline. Nevertheless, for sufferers who had a C. diff an infection within the prior 12 months, using doxycycline was related to a forty five% discount in antibiotic-associated C. diff an infection in comparison with azithromycin.
“Our evaluation discovered that in sufferers with a previous historical past of C. diff, doxycycline was the one issue related to a discount within the incidence of latest C. diff infections,” says Kari A. Mergenhagen, PharmD, BCPS, BCIDP, residency director for infectious ailments on the Veterans Affairs of Western New York Healthcare System and senior writer of the research, in a launch. “These outcomes recommend that in circumstances the place Legionella pneumonia may be dominated out previous to remedy, sufferers at elevated threat of C. diff might profit from using doxycycline as a first-line agent.”
Further findings from the research embrace:
- A complete of 1,234 sufferers have been identified with C. diff inside 30 days of beginning antibiotic remedy for pneumonia. That features 1,085 sufferers handled with azithromycin and 149 handled with doxycycline.
- Of the 1,234 sufferers who developed C. diff infections inside 30 days, 1,104 of them had no prior historical past of C. diff.
- Of the sufferers within the research, 1,064 had been identified with C. diff within the year-long interval previous to analysis with pneumonia.
- As a result of the inhabitants on this research got here from VA hospitals, the sufferers have been predominantly male, aged, and Caucasian. Further research shall be wanted to find out whether or not these findings maintain for different affected person populations.
“Healthcare amenities have a eager curiosity in lowering the incidence of harmful and expensive healthcare-associated C. diff infections,” says Patricia Jackson, RN, BSN, MA, CIC, FAPIC, 2023 Affiliation of Professionals in An infection Management and Epidemiology president, in a launch. “This research exhibits that for sufferers with a historical past of C. diff antibiotic selection is a crucial consider reducing some of these infections.”
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