Doxycycline or Cephalexin for Nonpurulent Soft Tissue Infections?

27 Jan 2024 • Soft-tissue infections are among the most common reasons for prescribing antibiotics. Treatment decisions are often empiric, with drug selection leaning toward beta-hemolytic streptococci in nonpurulent infection and Staphylococcus aureus in purulent infection. However, uncertainty around the effectiveness of tetracycline and trimethoprim/sulfamethoxazole (TMP/SMX) against streptococci has prompted use of cumbersome oral antibiotic regimens that challenge adherence.

As per recent findings, for mild, nonpurulent soft tissue infections, failure rates were similar with either antibiotic.

Patients receiving ≤14 days doxycycline versus cephalexin monotherapy for outpatient treatment of nonpurulent (presumed streptococcal) skin and soft tissue infection, a low rate of 14-day clinical failure was observed [6% each group; defined as hospital admission, i.v. antibiotic therapy, or change in oral antibiotic.

Doxycycline may represent a reasonable therapeutic alternative for this indication in regions with low tetracycline resistance.

Source: NEJM J-Watch | Read full story

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