Doxycycline

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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

  • 20mg 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