Background. Community acquired pneumonia (CAP) is a common serious infection that is usually treated with a macrolide with a β-lactam while doxycycline is considered an alternative due to limited evidence. Hence, we aimed to evaluate azithromycin versus doxycycline containing regimen in achieving clinical stability for inpatients with CAP. Materials and Methods. a retrospective cohort of inpatients with CAP receiving either azithromycin or doxycycline combined with a β-lactam. The primary endpoint was the percentage of patients who achieved clinical stability within 3 days, while secondary endpoints were the average days required to achieve clinical stability. Results. A total of 447 were included of which 379 received azithromycin while 68 received doxycycline containing regimen. The average age of the study population was 65.4 ± 21.1, of which 49% were females. Ceftriaxone was the most prescribed β-lactam. Majority of this cohort had a length of hospital stay of 5 days or less. Total percentage of patients who achieved clinical stability within 3 days were 257 (57.5%), of which 222 (58.6%) were in azithromycin group versus 35 (51.5%) in doxycycline containing regimen group; p = 0.275 . While the average day required to achieve clinical stability in both groups was 3.8 ± 3.2, in which 3.8 ± 3.3 in azithromycin versus 3.9 ± 2.7 in doxycycline containing regimen; (95% CI −0.98–0.68; p = 0.727 ) Conclusions. These findings support that doxycycline is comparable in efficacy to macrolides with a β-lactam for inpatients with CAP as supported by current guideline recommendations.
BackgroundColistin antibiotic is considered a valuable and last-resort therapeutic option for MDR gram-negative bacteria. Nephrotoxicity is the most clinically pertinent adverse effect for colistin. Vivo studies suggest that administering oxidative stress-reducing agents, such as ascorbic acid, is a promising strategy to overcome colistin-induced nephrotoxicity (CIN). However, limited clinical data explores the potential benefit of adjunctive ascorbic acid therapy for preventing CIN. Therefore, this study aims to assess the potential nephroprotective role of ascorbic acid as adjunctive therapy against CIN in critically ill patients. MethodThis was a retrospective cohort study at King Abdulaziz Medical City (KAMC) for all adult critically ill patients who have received IV Colistin. Eligible patients were classified into two groups based on the ascorbic acid use as concomitant therapy within three days of colistin initiation. The primary outcome was CIN odds after colistin initiation, while the secondary outcomes were 30-day mortality, in-hospital mortality, ICU, and hospital LOS. Propensity score (PS) matching was used (1:1 ratio) based on the patient’s age, SOFA score, and serum creatinine. ResultsA total of 451 patients were screened for eligibility; 90 patients were included after propensity score matching based on the selected criteria. The odds of developing CIN after colistin initiation were similar between patients who received ascorbic acid (AA) as adjunctive therapy compared to patients who did not (OR (95%CI): 0.83 (0.33, 2.10), p-value=0.68). In addition, the 30-day mortality, in-hospital mortality, ICU, and hospital LOS were similar between the two groups. ConclusionConcomitant use of Ascorbic acid with colistin was not associated with lower odds of colistin-induced nephrotoxicity. Further studies with a larger sample size are required to confirm these findings.
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