From the Guidelines
Azithromycin is a suitable macrolide to use in combination with doxycycline for treating certain urinary tract infections, particularly those caused by atypical pathogens like Mycoplasma genitalium or Chlamydia trachomatis, with a typical regimen being azithromycin 1 gram as a single oral dose along with doxycycline 100 mg twice daily for 7 days. This combination provides broad coverage against both typical and atypical urinary pathogens. However, it's essential to note that macrolides are not typically first-line agents for uncomplicated UTIs, which are usually treated with trimethoprim-sulfamethoxazole, nitrofurantoin, or fluoroquinolones, as recommended by the Infectious Diseases Society of America (IDSA) guidelines 1. The doxycycline-azithromycin combination is more commonly used for suspected co-infection with sexually transmitted infections or for complicated UTIs with suspected atypical pathogens. This combination works well because azithromycin has good tissue penetration and a long half-life, while doxycycline provides complementary coverage against a range of gram-positive and gram-negative organisms.
Some key points to consider when treating UTIs include:
- Using first-line therapy dependent on the local antibiogram, such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, as recommended by the AUA/CUA/SUFU guideline 1.
- Treating recurrent UTI patients with as short a duration of antibiotics as reasonable, generally no longer than seven days, as suggested by the AUA/CUA/SUFU guideline 1.
- Considering the concepts of resistance prevalence and collateral damage when choosing UTI treatments, as introduced by the IDSA guidelines 1.
- Reserving fluoroquinolones for important uses other than acute cystitis due to their propensity for collateral damage, as recommended by the IDSA guidelines 1 and the American College of Physicians 1.
Patients should complete the full course of antibiotics even if symptoms improve before completion, to ensure effective treatment and prevent the development of antibiotic resistance. The most recent and highest quality study, published in 2021 by the American College of Physicians 1, provides best practice advice for the use of short-course antibiotics in common infections, including UTIs.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Macrolide Options for UTI with Doxycycline
- There are no specific macrolide options mentioned in the provided studies for the treatment of UTI with doxycycline 2, 3, 4, 5, 6.
- The studies primarily discuss the treatment options for urinary tract infections (UTIs) caused by antibiotic-resistant Gram-negative bacteria, including the use of nitrofurantoin, fosfomycin, fluoroquinolones, and β-lactams 2, 3.
- Doxycycline is not mentioned as a primary treatment option for UTIs in the provided studies 2, 3, 4, 5, 6.
- Macrolides are not recommended as a first-line treatment for UTIs, and their use is not discussed in the context of doxycycline 2, 3, 4, 5, 6.
Alternative Treatment Options
- The recommended first-line empiric therapies for acute uncomplicated bacterial cystitis include a 5-day course of nitrofurantoin or a 3-g single dose of fosfomycin tromethamine 2, 3.
- Second-line options include fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 2, 3.
- Current treatment options for UTIs due to AmpC- β-lactamase-producing organisms include fosfomycin, nitrofurantoin, fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems 2, 3.