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This study examined antibiotic prescription patterns at a Boston sexual health clinic before and after implementing doxycycline post-exposure prophylaxis (doxy-PEP) for preventing bacterial sexually transmitted infections in men who have sex with men and transgender women. While individuals using doxy-PEP received 3.4 times more antibiotic prescriptions than non-users, the overall cohort prescription rate increased only 1.4-fold, and non-users experienced reduced antibiotic exposure due to fewer STI infections. The findings suggest doxy-PEP creates a trade-off: increased antibiotic selection pressure in users but decreased pressure in non-users through reduced STI transmission.
Why it matters
This research addresses a critical concern about doxy-PEP implementation—whether preventing STIs through prophylactic antibiotics might accelerate antimicrobial resistance. The findings suggest the intervention may redistribute rather than dramatically increase overall antibiotic exposure in this population, which has important implications for public health policy decisions about doxy-PEP adoption.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: Doxycycline post-exposure prophylaxis (doxy-PEP) reduces the incidence of bacterial sexually transmitted infections (STIs) among men who have sex with men and transgender women (MSMTW), but it may select for antimicrobial resistance (AMR). AMR development will depend in part how doxy-PEP changes rates of antibiotic use. Methods: We conducted a retrospective electronic medical record review of antibiotic prescriptions received by patients at the Massachusetts General Hospital Sexual Health Clinic from January 1, 2023, to December 27, 2025. Using a Bayesian negative binomial regression, we assessed the direct, indirect, and combined effects of doxy-PEP implementation on antibiotic prescription rates among doxy-PEP-eligible MSMTW who were receiving HIV pre-exposure prophylaxis. Results: Controlling for direct effects, the cohort’s total antibiotic prescription rate decreased by 10% (0.90, 95% CI 0.87 – 0.94) for every 100 doxy-PEP starts. Doxy-PEP users were prescribed antibiotics at double the rate predicted in the absence of doxy-PEP implementation, and, controlling for indirect effects, received 3.40 (95% CI 2.95 – 3.91) times the antibiotic prescriptions of patients not using doxy-PEP. Doxy-PEP non-users were prescribed antibiotics at less than half the rate predicted in the absence of doxy-PEP. The full cohort’s overall antibiotic prescription rate increased by 1.4 times after doxy-PEP implementation. Conclusions: Individuals who are taking doxy-PEP have higher antibiotic prescription rates, increasing selection for antibiotic-resistant bacteria in these individuals. However, doxy-PEP-driven decreases in the overall incidence of bacterial STIs have the potential to decrease selective pressure for resistant organisms in those not using doxy-PEP.