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Clostridium difficile infection (CDI) is a growing problem among hospitalized patients, occurring at a rate of 6.5 to 8.5 cases per 10,000 patient-days. Antibiotic therapy is a major risk factor, but the risk is higher with some antibiotics than with others. Doxycycline has been shown to have low potential to cause CDI and may even protect against it.
To explore this issue further, researchers performed a retrospective study of adult patients admitted to San Francisco General Hospital between June 2005 and December 2010 who received at least one dose of ceftriaxone. Among these 2305 patients, 43 (5 who received doxycycline, 38 who did not) developed CDI within 30 days of admission. Multivariate analysis revealed a 71% reduction in the CDI rate among patients receiving doxycycline compared with those not receiving it. A 5-day course of doxycycline plus ceftriaxone had a hazard ratio for CDI of 0.15 compared with 5 days of a macrolide plus ceftriaxone, and 0.13 compared with 5 days of a fluoroquinolone plus ceftriaxone.
Doernberg SB et al. Does doxycycline protect against development of Clostridium difficile infection? Clin Infect Dis 2012 Sep 1; 55:615.
Comment
In this historical study, the CDI rate was markedly lower in patients receiving doxycycline plus ceftriaxone than in those receiving ceftriaxone alone or together with other antibiotics. The mechanism for this reduction is not known. That the risk was ≥85% lower with doxycycline plus ceftriaxone than with either of the regimens most commonly used for the empirical therapy of community-acquired pneumonia in hospitalized patients (ceftriaxone plus either a macrolide or a fluoroquinolone) strongly suggests a change to doxycycline in this circumstance.