Doxycycline: Difference between revisions

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==General==
==General==
*Type: [[Tetracyclines]]
*Type: [[Is DrugClass::Tetracyclines]]
*Dosage Forms:
*Dosage Forms: PO and IV (20mg, 50mg, 75mg, 100mg, 150mg, 25mg/5 mL)
*Common Trade Names:  
*Common Trade Names: Adoxa, Avidoxy, Doryx, Monodox, Oracea, Periostat, Vibramycin


==Adult Dosing==
==Adult Dosing==
===General Infections===
*100mg PO/IV QD or q12h depending on severity
**Variable duration
===Severe Acne Vulgaris===
*100mg PO QD
**Start 100mg PO q12h x 1 day
===Periodontitis===
*200mg PO q12h
===Acute Bacterial Sinusitis===
*200mg/day PO q12-24h x 5-7 days
===[[Chlamydia]]===
*100mg PO q12h x 7 days
*Also prophylaxis for sexual assault victims
===[[Gonorrhea]]===
*100mg PO q12h x 7 days
*Not first line- use with [[ceftriaxone]]
===[[PID]]===
*Outpatient
**100mg PO q12h x 14 days
*Inpatient
**100mg IV q12h x 14 days
**Switch to PO when able and complete course
===Cervicitis===
*100mg PO q12h x 7 days
===[[Syphilis]]===
If hypersensitivity to Penicillin
====Primary/Secondary/Latent<1 year====
*100mg PO q12h x 14 days
====Latent >1 year/unknown====
*100mg PO q12h x 28 days
===Lymphogranuloma Venereum===
*100mg PO q12h x 21 days
===Urethritis===
*100mg PO q12h x 7 days
===[[Epididymitis]]===
*100mg PO q12h x 10 days
===[[Proctitis]]===
*100mg PO q12h x 7 days
===[[Lyme Disease]]===
*100mg PO q12h x14-21 days
*Treat for 28 days if Lyme arthritis
===[[Anthrax]]===
First line agent in pregnancy
====Inhalational, GI, Oropharyngeal====
*100mg PO q12h x 60 days
====Cutaneous====
*100mg PO q12h x 7-10 days
*60 day regimen if bioterrorism suspected
====Post exposure prophylaxis====
*100mg PO QD x 60 days or until anthrax exposure excluded
===[[Malaria]] prophylaxis===
*100mg PO QD
**Start 1-2 days prior to exposure
**Continue 4 weeks after exposure


==Pediatric Dosing==
==Pediatric Dosing==
===General Infections===
*>8 years old
*2.2mg/kg PO/IV QD
**Start: 2.2mg/kg PO/IV q12h x 1 day
**Max 100mg/kg/dose
**Frequency for severe infections is q12h
===Severe Acne Vulgaris===
*>8 years old
*2.2mg/kg PO/IV QD
**Start: 2.2mg/kg PO/IV q12h x 1 day
**Max 100mg/kg/dose
===Atypical CAP===
*>8 years old
*2-4mg/kg/day PO divided q12h x7-10 days
===[[Chlamydia]]===
*>8 years old
*100mg PO q12h x 7 days
*Also prophylaxis for sexual assault victims
===[[Gonorrhea]]===
*>8 years old/>45 kg
*100mg PO q12h x 7 days
*Not first line- use with [[ceftriaxone]]
===[[PID]]===
*Same as adult dosing
===Cervicitis===
*Adolescents
*100mg PO q12h x 7 days
===Lymphogranuloma Venereum===
*Adolescents
*100mg PO q12h x 21 days
===Urethritis===
*Adolescents
*100mg PO q12h x 7 days
===[[Epididymitis]]===
*Adolescents
*100mg PO q12h x 10 days
===[[Proctitis]]===
*Adolescents
*100mg PO q12h x 7 days
===[[Lyme Disease]]===
*>8 years old
*100mg PO q12h x14-21 days
*Treat for 28 days if Lyme arthritis
===[[Anthrax]]===
First line agent in pregnancy
====Inhalational, GI, Oropharyngeal====
*2.2mg/kg PO q12h x 60 days
====Cutaneous====
*2.2mg/kg PO q12h x 7-10 days
*Max 100mg/dose
*60 day regimen if bioterrorism suspected
====Post exposure prophylaxis====
*2.2mg/kg PO QD x 60 days or until anthrax exposure excluded
*Max 100mg/dose
===[[Malaria]] prophylaxis===
*> 8 years old
*2.2mg/kg PO QD
**Start 1-2 days prior to exposure
**Continue 4 weeks after exposure
**Max 100mg/dose


==Special Populations==
==Special Populations==
*Pregnancy:
*Pregnancy: D
*Lactation:
*Lactation: Possibly Unsafe; consider alternatives
*Renal Dosing
*Renal Dosing Adult and Pediatric
**Adult
**No adjustment
**Pediatric
*Hepatic Dosing Adult and Pediatric
*Hepatic Dosing
**Not defined
**Adult
**Pediatric


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug
*Pregnancy
*Age <8 years
**Doxycycline is less likely to cause dental staining, especially short course
**AAP now permits Doxycyline use if less than 21 days treatment duration<ref>American Academy of Pediatrics. Tetracyclines. In: Red Book: 2018 Report of the Committee on Infectious Diseases, 31st ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Itasca, IL 2018. p.905.</ref>
*Caution:
**Lupus
**Child bearing potential
**Hepatic impairment
**Candidiasis
**Recent colitis due to antibiotics


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Tooth discoloration children <8 years old ''(Controversial)''<ref>The end of a dogma: the safety of doxycycline use in young children for malaria treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390373/</ref>
*Photosensitivity
*C. Diff diarrhea
*Hypersensitivity reaction
*Skin reaction
*Vasculitis
*Pericarditis
*Autoimmune hepatitis
*Hepatotoxicity
*Nephrotoxicity
*Esophagitis/ulcer
*[[Pancreatitis]]
*[[Thrombocytopenia]]
*[[Neutropenia]]
*Hemolytic anemia
*[[Pseudotumor cerebri]]
*Bulging fontanelles
*Jarisch-Herxheimer reaction
*Fetal harm


===Common===
===Common===
*Headache
*Nausea
*Dyspepsia
*Arthralgia
*[[Diarrhea]]
*Rash
*Dysmenorrhea
*Photosensitivity
*Vulvovaginal candidiasis
*Skin discoloration
*Elevated BUN


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 18 hours
*Metabolism:  
*Metabolism: Unknown and minimal liver/CYP450
*Excretion:  
*Excretion: Feces and urine
*Mechanism of Action:
*Mechanism of Action: Bacteriostatic


==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
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===Key===
===Key===
{{Template:Antibacterial Spectra Key}}
{{Template:Antibacterial Spectra Key}}
==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]

Latest revision as of 15:14, 18 July 2025

General

  • Type: Tetracyclines
  • Dosage Forms: PO and IV (20mg, 50mg, 75mg, 100mg, 150mg, 25mg/5 mL)
  • Common Trade Names: Adoxa, Avidoxy, Doryx, Monodox, Oracea, Periostat, Vibramycin

Adult Dosing

General Infections

  • 100mg PO/IV QD or q12h depending on severity
    • Variable duration

Severe Acne Vulgaris

  • 100mg PO QD
    • Start 100mg PO q12h x 1 day

Periodontitis

  • 200mg PO q12h

Acute Bacterial Sinusitis

  • 200mg/day PO q12-24h x 5-7 days

Chlamydia

  • 100mg PO q12h x 7 days
  • Also prophylaxis for sexual assault victims

Gonorrhea

  • 100mg PO q12h x 7 days
  • Not first line- use with ceftriaxone

PID

  • Outpatient
    • 100mg PO q12h x 14 days
  • Inpatient
    • 100mg IV q12h x 14 days
    • Switch to PO when able and complete course

Cervicitis

  • 100mg PO q12h x 7 days

Syphilis

If hypersensitivity to Penicillin

Primary/Secondary/Latent<1 year

  • 100mg PO q12h x 14 days

Latent >1 year/unknown

  • 100mg PO q12h x 28 days

Lymphogranuloma Venereum

  • 100mg PO q12h x 21 days

Urethritis

  • 100mg PO q12h x 7 days

Epididymitis

  • 100mg PO q12h x 10 days

Proctitis

  • 100mg PO q12h x 7 days

Lyme Disease

  • 100mg PO q12h x14-21 days
  • Treat for 28 days if Lyme arthritis

Anthrax

First line agent in pregnancy

Inhalational, GI, Oropharyngeal

  • 100mg PO q12h x 60 days

Cutaneous

  • 100mg PO q12h x 7-10 days
  • 60 day regimen if bioterrorism suspected

Post exposure prophylaxis

  • 100mg PO QD x 60 days or until anthrax exposure excluded

Malaria prophylaxis

  • 100mg PO QD
    • Start 1-2 days prior to exposure
    • Continue 4 weeks after exposure

Pediatric Dosing

General Infections

  • >8 years old
  • 2.2mg/kg PO/IV QD
    • Start: 2.2mg/kg PO/IV q12h x 1 day
    • Max 100mg/kg/dose
    • Frequency for severe infections is q12h

Severe Acne Vulgaris

  • >8 years old
  • 2.2mg/kg PO/IV QD
    • Start: 2.2mg/kg PO/IV q12h x 1 day
    • Max 100mg/kg/dose

Atypical CAP

  • >8 years old
  • 2-4mg/kg/day PO divided q12h x7-10 days

Chlamydia

  • >8 years old
  • 100mg PO q12h x 7 days
  • Also prophylaxis for sexual assault victims

Gonorrhea

  • >8 years old/>45 kg
  • 100mg PO q12h x 7 days
  • Not first line- use with ceftriaxone

PID

  • Same as adult dosing

Cervicitis

  • Adolescents
  • 100mg PO q12h x 7 days

Lymphogranuloma Venereum

  • Adolescents
  • 100mg PO q12h x 21 days

Urethritis

  • Adolescents
  • 100mg PO q12h x 7 days

Epididymitis

  • Adolescents
  • 100mg PO q12h x 10 days

Proctitis

  • Adolescents
  • 100mg PO q12h x 7 days

Lyme Disease

  • >8 years old
  • 100mg PO q12h x14-21 days
  • Treat for 28 days if Lyme arthritis

Anthrax

First line agent in pregnancy

Inhalational, GI, Oropharyngeal

  • 2.2mg/kg PO q12h x 60 days

Cutaneous

  • 2.2mg/kg PO q12h x 7-10 days
  • Max 100mg/dose
  • 60 day regimen if bioterrorism suspected

Post exposure prophylaxis

  • 2.2mg/kg PO QD x 60 days or until anthrax exposure excluded
  • Max 100mg/dose

Malaria prophylaxis

  • > 8 years old
  • 2.2mg/kg PO QD
    • Start 1-2 days prior to exposure
    • Continue 4 weeks after exposure
    • Max 100mg/dose

Special Populations

  • Pregnancy: D
  • Lactation: Possibly Unsafe; consider alternatives
  • Renal Dosing Adult and Pediatric
    • No adjustment
  • Hepatic Dosing Adult and Pediatric
    • Not defined

Contraindications

  • Allergy to class/drug
  • Pregnancy
  • Age <8 years
    • Doxycycline is less likely to cause dental staining, especially short course
    • AAP now permits Doxycyline use if less than 21 days treatment duration[1]
  • Caution:
    • Lupus
    • Child bearing potential
    • Hepatic impairment
    • Candidiasis
    • Recent colitis due to antibiotics

Adverse Reactions

Serious

  • Tooth discoloration children <8 years old (Controversial)[2]
  • Photosensitivity
  • C. Diff diarrhea
  • Hypersensitivity reaction
  • Skin reaction
  • Vasculitis
  • Pericarditis
  • Autoimmune hepatitis
  • Hepatotoxicity
  • Nephrotoxicity
  • Esophagitis/ulcer
  • Pancreatitis
  • Thrombocytopenia
  • Neutropenia
  • Hemolytic anemia
  • Pseudotumor cerebri
  • Bulging fontanelles
  • Jarisch-Herxheimer reaction
  • Fetal harm

Common

  • Headache
  • Nausea
  • Dyspepsia
  • Arthralgia
  • Diarrhea
  • Rash
  • Dysmenorrhea
  • Photosensitivity
  • Vulvovaginal candidiasis
  • Skin discoloration
  • Elevated BUN

Pharmacology

  • Half-life: 18 hours
  • Metabolism: Unknown and minimal liver/CYP450
  • Excretion: Feces and urine
  • Mechanism of Action: Bacteriostatic

Antibiotic Sensitivities[3]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G I
Strep. Pneumoniae S
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium R
MSSA I
MRSA I
CA-MRSA S
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp I
E. coli/Klebsiella ESBL+ I
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp X1
Serratia marcescens R
Salmonella sp I
Shigella sp I
Proteus mirabilis X1
Proteus vulgaris R
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia X2
Yersinia enterocolitica R
Francisella tularensis S
Brucella sp. S
Legionella sp. X2
Pasteurella multocida X1
Haemophilus ducreyi R
Vibrio vulnificus S+'
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp S
Mycobacterium avium R
Anaerobes Actinomyces S
Bacteroides fragilis I
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum X1
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ American Academy of Pediatrics. Tetracyclines. In: Red Book: 2018 Report of the Committee on Infectious Diseases, 31st ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Itasca, IL 2018. p.905.
  2. ↑ The end of a dogma: the safety of doxycycline use in young children for malaria treatment https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390373/
  3. ↑ Sanford Guide to Antimicrobial Therapy 2014
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