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
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]
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
- 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.
- 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/
- Sanford Guide to Antimicrobial Therapy 2014
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