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Evaluating the use of doxycycline versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus-associated acute pulmonary exacerbations in people with cystic fibrosis
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  • Kendall H. Brickel,
  • Denise Kelley,
  • Hai Quyen Tran,
  • Jason Fullmer,
  • Danielle Beachler
Kendall H. Brickel
Dell Seton Medical Center at The University of Texas

Corresponding Author:[email protected]

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Denise Kelley
Dell Seton Medical Center at The University of Texas
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Hai Quyen Tran
Dell Children's Medical Center of Central Texas
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Jason Fullmer
Dell Children's Medical Center of Central Texas
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Danielle Beachler
Dell Children's Medical Center of Central Texas
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Abstract

Background: Among patients with cystic fibrosis (CF), methicillin-resistant Staphylococcus aureus (MRSA)-associated acute pulmonary exacerbations (APEs) are increasing in prevalence and can cause rapid declines in lung function and mortality. Limited data exist on the preferred treatment of MRSA-associated APEs, with vancomycin often considered first-line. Given the potential toxicities and intolerances associated with vancomycin, evaluating alternative therapies such as doxycycline is warranted. Methods: This evaluation is a multicenter retrospective cohort study of adult and pediatric patients with a CF diagnosis who received greater than 48 hrs of either vancomycin or doxycycline to treat MRSA-associated APEs. The primary outcome was the incidence of patients with a return to ≥90% of baseline forced expiratory volume in the first second (FEV 1). Results: 229 patient encounters were 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 versus 51/63 (81.0%) in the doxycycline group (p = 0.23). Conclusions: Doxycycline was comparable to vancomycin in the rate of return to ≥90% of baseline FEV 1 and for all secondary efficacy outcomes. While the results of this study are limited by the small sample size, retrospective design, and lack of power, the findings suggest doxycycline may be a reasonable alternative to vancomycin for MRSA-associated APEs, particularly in patients who may not tolerate vancomycin or who require concomitant nephrotoxins such as intravenous aminoglycosides.
30 Jul 2023Submitted to Pediatric Pulmonology
31 Jul 2023Assigned to Editor
31 Jul 2023Submission Checks Completed
31 Jul 2023Review(s) Completed, Editorial Evaluation Pending
13 Aug 2023Reviewer(s) Assigned
27 Sep 2023Editorial Decision: Revise Major