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
• 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

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

• Antibiotics (Main)

Source

• Epocrates

Authors

Colin Hoff, Ross Donaldson, Neil Young, Claire, Daniel Ostermayer