Beta-lactam antibiotics plus doxycycline are an alternative to azithromycin in severe community-acquired pneumonia

Beta-lactam antibiotics plus doxycycline demonstrated comparable outcomes to beta-lactam antibiotics plus azithromycin in adults hospitalised with severe community-acquired pneumonia (CAP).

The analysis was based on a retrospective, real-world study using data from the MIMIC-IV database spanning from 2008 to 2019, including hospitalised adults with severe pneumonia who received a beta-lactam antibiotic plus either azithromycin or doxycycline. Dr Wigdan Farah (Mayo Clinic, MN, USA) presented the results [1]. Primary outcomes included the need for mechanical ventilation and mortality. The analysis included 1,191 participants who received a beta-lactam antibiotic plus azithromycin and 116 participants who received a beta-lactam antibiotic plus doxycycline.

There was no significant difference in invasive or non-invasive mechanical ventilation or all-cause mortality between groups. However, there was a trend towards higher rates of invasive ventilation in the azithromycin group and higher mortality in the doxycycline group. The results remained consistent after adjustment for baseline comorbidities.

“When I think of all of the results, beta-lactam antibiotics plus doxycycline could be a comparable option for patients and support its use as an effective alternative to azithromycin for empiric treatment,” concluded Dr Farah. “This offers clinicians an additional option when treating CAP.”

1. Farah W, et al. Azithromycin vs. doxycycline in community-acquired pneumonia: An analysis of clinical outcomes from the MIMIC IV database. ERS Congress, 27 September–1 October 2025, Amsterdam, The Netherlands.

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Posted on 30 October 2025