Doxycycline

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




Indications by Disease

DiseaseDoseContext
Acne vulgaris100mg PO dailySevere acne vulgaris
Acute diarrhea300mg PO as single doseVibrio cholerae
Acute necrotizing ulcerative gingivitis100 mg PO BID x 10 daysUncomplicated
Anthrax100mg IV q12hrs x 60 daysInhalation/cutaneous with systemic illness; only if allergic to ciprofloxacin
Anthrax100mg PO q12hrs x 60 daysPostexposure prophylaxis
Anthrax100mg PO q12hrs x 60 daysCutaneous anthrax, not systemically ill
Bell's palsyempiric dosingLyme Suspicion
Cellulitis100mg PO/IV q12hrs dailySaltwater
Cervicitis100 mg PO BID x 7 daysGC/Chlamydia, Nonpregnant
Chlamydia trachomatis100mg PO q12h x 7 days; Also prophylaxis for sexual assault victimsChlamydia
Diabetic foot infection100mg PO q12hrs daily x 14 daysMild DFI
Ehrlichiosis100mg PO/IV BID x 14 daysAdults
Encephalitis200 mg IV once followed by 100 mg IV twice dailyTick Associated
Epididymitis100 mg orally twice a day for 10 daysSTI
Gonorrheal conjunctivitis100mg PO BID for 7 daysChlamydial Conjunctivitis
Infectious tenosynovitis100mg PO twice dailyGonococcal
Lymphogranuloma venereum100mg PO BID x 21 daysFirst Choice
Malaria100mg PO dailyProphylaxis
Mammalian bites100mg PO BID x 14 daysCat and dog bites penicillin allergic
Pelvic inflammatory disease100mg PO or IV q12hrInpatient
Pelvic inflammatory disease100mg PO BID x 14 daysOutpatient
Periodontitis100mg PO daily (as adjunct to scaling and root planing)Periodontitis
Plague200mg (2.2mg/kg) PO/IV dailyActive disease
Plague100mg (2.2mg/kg) PO q12hrsPostexposure prophylaxis
Pneumonia (main)100 mg BIDOutpatient, Unhealthy
Pneumonia (main)100mg IV/PO BIDInpatient, CAP Non-ICU
Pneumonia (main)100 mg twice dailyOutpatient, Healthy
Postpartum endometritis100mg IV/PO q12hrs<48hrs postpartum; combined with Ampicillin/Sulbactam or Cefoxitin
Postpartum endometritis100mg IV or PO q12hrs>48hrs postpartum; combined with Metronidazole
Proctitis100mg PO q12h x 7 daysProctitis
Prostatitis100mg PO q12 hrs x14 daysSTD Associated
Rocky mountain spotted fever100mg PO BID x 5-7 daysFirst line
Syphilis100mg oral twice daily for 4 weeksLate Stage, Alternative
Syphilis100mg oral twice daily for 14 daysEarly Stage, Alternative
Tularemia100mg (2.2mg/kg) IV q12hrs x 14 daysActive disease
Tularemia100mg PO q12hrs x 14 daysPostexposure prophylaxis
Urethritis in men100 mg PO BID x 7 daysUncomplicated, Chlamydia

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








Indications by Disease

DiseaseDoseContext
Acne vulgaris>8 years old: weight <45kg: 2.2mg/kg/dose PO QD-BID; weight >45kg: adult dosingSevere acne vulgaris
Anthrax2.2mg/kg PO q12hrs x 60 daysPediatric postexposure prophylaxis
Anthrax2.2mg/kg IV q12hrsPediatric; only if allergic to cipro
Chlamydia trachomatis>8 years old; 100mg PO q12h x 7 days; Also prophylaxis for sexual assault victimsChlamydia
Ehrlichiosis2.2mg/kg PO/IV BIDPediatric under 45kg
Encephalitis2.2mg/kg IV q12hrs (max 100mg/dose)Pediatric Tick Associated
Lyme disease>8 years old; 100mg PO q12h x14-21 days; Treat for 28 days if Lyme arthritisLyme Disease
Malaria2.2 mg/kg/day PO daily (max 100mg/day), >8 years oldProphylaxis
Neisseria gonorrhoeae>8 years old/>45 kg; 100mg PO q12h x 7 days; Not first line- use with ceftriaxoneGonorrhea
Plague2.2mg/kg PO/IV q12hrs (max 100mg/dose)Pediatric Active Disease/Prophylaxis
ProctitisAdolescents; 100mg PO q12h x 7 daysProctitis
Rocky mountain spotted fever2.2mg/kg PO/IV BID (max 100mg/dose) x 5-7 days or until afebrile x 3 daysPediatric First Line
Tularemia2.2mg/kg PO/IV q12hrs x 14 days (max 100mg/dose)Pediatric Active Disease/Prophylaxis

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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