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Doxycycline is often a last-choice agent for managing community-acquired pneumonia (CAP). The most recent U.S. guidelines do list doxycycline as a treatment option for outpatient CAP, but the recommendation is rated as conditional with “low quality of evidence” (NEJM JW Gen Med Dec 1 2019 and Am J Respir Crit Care Med 2019; 200:45), and British guidelines display a similar lack of enthusiasm. As rates of β-lactam and macrolide resistance climb, though, the tetracyclines are getting a second look.
Investigators conducted a meta-analysis of six randomized clinical trials performed between 1984 and 2004 in which doxycycline was compared with other agents for CAP treatment. Among a total of 834 adult outpatients and inpatients, none of whom requ…