Efficacy of combination therapy with minocycline for treating Stenotrophomonas maltophilia infections
In brief
Adding minocycline raised bacterial clearance to 80% versus 56%, without improving survival
In a randomized trial of 112 adults, most of them in intensive care or with ventilator-associated pneumonia, adding minocycline to standard antibiotics increased bacterial clearance by the end of treatment from 56% to 80%. It did not improve clinical response or 28-day survival, so whether better clearance offers any meaningful patient benefit remains unclear.
- Journal
- JAC-antimicrobial resistance (Q1)
- Published
- 16 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Tuvanont Pongdumbun, Yong Rongrungruang, Adhiratha Boonyasiri
- PMID
- 42891078
- DOI
- 10.1093/jacamr/dlag224
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 18 October 2026): Adjunctive minocycline improves microbiological response in VAP
Abstract
BACKGROUND: Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen associated with substantial in-hospital mortality. However, data supporting the efficacy of treating S. maltophilia infections using a combination of antimicrobials remain inconclusive. OBJECTIVES: To assess whether adjunctive minocycline improves clinical outcomes of S. maltophilia infections compared with standard monotherapy. METHODS: This randomized, double-blind, placebo-controlled trial was conducted at Siriraj Hospital, Thailand. Adults with confirmed S. maltophilia infections were randomized to receive minocycline or a matching placebo in addition to monotherapy with either levofloxacin or trimethoprim/sulfamethoxazole. RESULTS: This trial enrolled 112 patients (71.4% [n = 80/112] of patients requiring an intensive care unit [ICU] and 66.1% [n = 74/112] of patients were diagnosed with ventilator-associated pneumonia [VAP]). Baseline demographic and clinical characteristics were balanced between intervention and control groups. Adjunctive minocycline did not significantly reduce 28-day-mortality (n = 24/55[43.6%] vs n = 22/57[38.6%], P = 0.590) but did achieve significantly higher microbiological response rates at early assessment (n = 25/55[45.5%] vs n = 8/57[14.0%], P < 0.001) and the end of treatment (n = 44/55[80.0%] vs n = 32/57[56.1%], P = 0.023). In contrast, clinical response rates did not differ between groups at either 72 h after the start of study treatment or the end of study treatment. In multivariable analysis, two factors were independently associated with 28-day mortality: history of antibiotic use before admission (adjusted odds ratio [aOR]: 7.65, 95% confidence interval [CI]: 2.04-28.76; P = 0.030) and septic shock (aOR: 7.24, 95% CI: 2.75-19.23; P < 0.001). CONCLUSIONS: Although adding minocycline to either levofloxacin or trimethoprim/sulfamethoxazole therapy enhanced microbiological eradication, it did not confer a measurable survival or clinical advantage. Combination therapy was well tolerated. This study is potentially of interest to those treating ICU patients, as the majority of infections were VAP.
Abstract as published, via PubMed.
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