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
  • Caution:
    • Lupus
    • Child bearing potential
    • Hepatic impairment
    • Candidiasis
    • Recent colitis due to antibiotics

Adverse Reactions

Serious

  • Tooth discoloration children <8 years old
  • 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[1]

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

Source

  • Epocrates
  1. Sanford Guide to Antimicrobial Therapy 2014