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Doxycycline Versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus Aureus-Associated Acute
Kendall H Brickel1, Denise Kelley1,2,3, Theresa Jaso4
1Department of Pharmacy, Dell Seton Medical Center, The University of Texas at Austin, Ascension Seton, Austin, TX, USA.
Background:
Among people with cystic fibrosis (PwCF), methicillin-resistant Staphylococcus aureus (MRSA)-associated acute pulmonary exacerbations (APEs) have been increasing in prevalence and can cause rapid declines in lung function and increased mortality. Fortunately, since 2019, incidence has started to decline.
Objective:
The purpose of this study was to evaluate if doxycycline has comparable efficacy to vancomycin for the treatment of APEs in PwCF. Given the potential toxicities and intolerances associated with vancomycin, evaluating alternative therapies such as doxycycline is warranted.
Methods:
A multicenter retrospective cohort study was conducted in adult and pediatric PwCF who received greater than 48 hours of either vancomycin or doxycycline to treat MRSA-associated APEs between May 1, 2014, and August 31, 2021. The primary outcome was the number of PwCF with a return to ≥90% of baseline forced expiratory volume in the first second (FEV1).
Results:
There were 229 PwCF encounters screened, of which 89 met inclusion criteria (n = 26, vancomycin; n = 63, doxycycline). There were no differences between vancomycin and doxycycline for the primary outcome: 18/26 (69.2%) in the vancomycin group vs 51/63 (81.0%) in the doxycycline group (P = 0.23). Secondary outcomes were similar between groups, including no difference in incidence of acute kidney injury (AKI), although a significantly higher incidence of adverse events occurred in the vancomycin arm.
Conclusion And Relevance:
The findings of this study suggest doxycycline may be a reasonable alternative to vancomycin for MRSA-associated APEs, particularly in PwCF who may not tolerate vancomycin or who require concomitant nephrotoxins such as intravenous (IV) aminoglycosides.
Insights
Doxycycline showed comparable efficacy to vancomycin in treating methicillin-resistant Staphylococcus aureus (MRSA)-associated pulmonary exacerbations in cystic fibrosis patients. This suggests doxycycline as a viable alternative, especially for those intolerant to vancomycin.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Pharmacology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA)-associated acute pulmonary exacerbations (APEs) pose a significant threat to people with cystic fibrosis (PwCF), leading to lung function decline and increased mortality.
- While the incidence of MRSA-associated APEs has seen a decline since 2019, effective treatment options remain crucial.
Purpose of the Study:
- To compare the efficacy of doxycycline versus vancomycin in treating MRSA-associated APEs in PwCF.
- To identify potential alternative therapies to vancomycin due to its associated toxicities and intolerances.
Main Methods:
- A multicenter retrospective cohort study included adult and pediatric PwCF treated for MRSA-associated APEs with vancomycin or doxycycline for over 48 hours.
- The primary outcome measured was the proportion of patients returning to at least 90% of their baseline forced expiratory volume in the first second (FEV1).
Main Results:
- No significant difference was observed in the primary outcome between the vancomycin and doxycycline groups (69.2% vs. 81.0%, P=0.23).
- Secondary outcomes, including acute kidney injury (AKI) incidence, were similar between groups.
- The vancomycin group experienced a significantly higher incidence of adverse events compared to the doxycycline group.
Conclusions:
- Doxycycline presents a potentially effective and well-tolerated alternative to vancomycin for treating MRSA-associated APEs in PwCF.
- This finding is particularly relevant for PwCF who may not tolerate vancomycin or require concurrent nephrotoxic medications.
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