What is doxycycline?

dox-i-SYE-kleen

Commonly used brand name(s)

In the U.S.

Adoxa
Adoxa CK
Adoxa Pak
Adoxa TT
Alodox
Doryx
Monodox
Oracea
Periostat
Vibramycin Calcium
Vibramycin Hyclate
Vibramycin Monohydrate
Vibra-Tabs

Available Dosage Forms:

Tablet
Powder for Suspension
Capsule
Capsule, Extended Release
Tablet, Delayed Release
Capsule, Delayed Release
Syrup

Therapeutic Class: Antibiotic

Chemical Class: Tetracycline (class)

Uses For doxycycline

Doxycycline is used to treat bacterial infections in many different parts of the body. It is also used to treat pimples and abscesses (usually on the face) that are caused by rosacea, also known as acne rosacea or adult acne.

Doxycycline delayed-release tablets and tablets are also used to prevent malaria and treat anthrax infection after possible exposure and other problems as determined by your doctor.

Doxycycline belongs to the class of medicines known as tetracycline antibiotics. It works by killing bacteria or preventing their growth. However, doxycycline will not work for colds, flu, or other virus infections.

doxycycline is available only with your doctor's prescription.

Before Using doxycycline

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For doxycycline, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to doxycycline or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Doxycycline may cause permanent discoloration of the teeth and slow down the growth of bones. doxycycline should not be given to children 8 years of age and younger (except for treatment of exposure to inhalational anthrax), unless directed by the child's doctor.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of doxycycline in the elderly. However, elderly patients are more likely to have kidney, liver, or heart problems which may require caution and an adjustment in the dose for patients receiving doxycycline.

Pregnancy

Pregnancy Category Explanation All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking doxycycline, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using doxycycline with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Acitretin

Using doxycycline with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Amoxicillin
Ampicillin
Bacampicillin
Bexarotene
Cloxacillin
Dicloxacillin
Digoxin
Etretinate
Isotretinoin
Methicillin
Methotrexate
Nafcillin
Oxacillin
Penicillin G
Penicillin G Benzathine
Penicillin G Procaine
Penicillin V
Piperacillin
Pivampicillin
Sultamicillin
Temocillin
Tretinoin

Using doxycycline with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Aluminum Carbonate, Basic
Aluminum Hydroxide
Aluminum Phosphate
Bismuth Subsalicylate
Calcium
Dihydroxyaluminum Aminoacetate
Dihydroxyaluminum Sodium Carbonate
Iron
Magaldrate
Magnesium Carbonate
Magnesium Hydroxide
Magnesium Oxide
Magnesium Trisilicate
Rifampin
Rifapentine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of doxycycline

Take doxycycline exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

doxycycline comes with a patient instructions. Read and follow the instructions carefully. Ask your doctor if you have any questions.

If you are using delayed-release tablets or tablets:

It may be taken with food or milk, if it upsets your stomach.
You may take doxycycline by breaking the tablets. Hold the tablet between your thumb and index fingers close to the appropriate score (separation) line. Then, apply enough pressure to snap the tablet segments apart. Do not use the tablet if it does not break on the scored lines.
You may also take doxycycline by sprinkling the equally broken tablets onto cold, soft food such as an applesauce. This mixture must be swallowed immediately without chewing and followed with a glass of cool water to ensure complete swallowing of the pellets. Do not store the mixture for later use.

Swallow the capsule whole. Do not break, crush, chew, or open it.

Shake the oral liquid well just before each use. Measure the dose with a marked measuring spoon, oral syringe, or medicine cup.

Drink plenty of fluids to avoid throat irritation and ulceration.

If you are using doxycycline to prevent malaria while traveling, start taking the medicine 1 or 2 days before you travel. Take the medicine every day during your trip and continue taking it for 4 weeks after you return. However, do not use the medicine for longer than 4 months.

If you are using For Oracea™ delayed-release capsules:

You should take doxycycline on an empty stomach, preferably at least 1 hour before or 2 hours after meals.
You should take doxycycline with a full glass of water while sitting or standing.
To prevent throat irritation, do not lay down right after taking doxycycline.

Use only the brand of doxycycline that your doctor prescribed. Different brands may not work the same way.

To help clear up your infection completely, keep taking doxycycline for the full time of treatment, even if you begin to feel better after a few days. If you stop taking doxycycline too soon, your symptoms may return.

Dosing

The dose of doxycycline will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of doxycycline. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage forms (capsules, delayed-release tablets, suspension, syrup, tablets):
- For infections:
  - Adults—100 milligrams (mg) every 12 hours on the first day, then 100 mg once a day or 50 to 100 mg every 12 hours.
  - Children older than 8 years of age who weigh 45 kg or less—Dose is based on body weight and must be determined by your doctor. The dose is usually 4.4 milligrams (mg) per kilogram (kg) of body weight per day and divided into two doses on the first day of treatment. This is followed by 2.2 mg per kg of body weight per day, taken as a single dose or divided into two doses on the following days.
  - Children up to 8 years of age—Use is not recommended.
- For the prevention of malaria:
  - Adults—100 milligrams (mg) once a day. You should take the first dose 1 or 2 days before travel to an area where malaria may occur, and continue taking the medicine every day throughout travel and for 4 weeks after you leave the malarious area.
  - Children older than 8 years of age—Dose is based on body weight and must be determined by your doctor. The dose is usually 2 milligrams (mg) per kilogram (kg) of body weight per day, taken as a single dose. You should take the first dose 1 or 2 days before travel to an area where malaria may occur, and continue taking the medicine every day throughout travel and for 4 weeks after you leave the malarious area.
  - Children up to 8 years of age—Use is not recommended.
- For anthrax after possible exposure:
  - Adults and children weighing 45 kilograms (kg) or more—100 milligrams (mg) two times a day (taken every 12 hours) for 60 days.
  - Children weighing less than 45 kg—Dose is based on body weight and must be determined by your doctor. The dose is usually 2.2 milligrams (mg) per kilogram (kg) of body weight per day, two times a day for 60 days.
For oral dosage form (delayed-release capsules):
- For the treatment of pimples from rosacea:
  - Adults—40 milligrams (mg) or one capsule once a day, in the morning.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of doxycycline, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using doxycycline

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

Using doxycycline while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using doxycycline, tell your doctor right away.

doxycycline may darken the color of your skin, nails, eyes, teeth, gums, or scars. Talk with your doctor if you have any concerns.

Doxycycline may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you stop taking doxycycline. Do not take any medicine to treat diarrhea without first checking with your doctor. Diarrhea medicines may make the diarrhea worse or make it last longer. If you have any questions about this or if mild diarrhea continues or gets worse, check with your doctor.

Birth control pills (containing estrogen) may not work properly while you are using doxycycline. To keep from getting pregnant, use other forms of birth control. These include condoms, a diaphragm, or contraceptive foam or jelly.

Doxycycline may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking doxycycline:

Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
Wear protective clothing, including a hat. Also, wear sunglasses.
Apply a sunblock product that has a sun protection factor (SPF) number of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your doctor.
Apply a sunblock lipstick that has an SPF of at least 15 to protect your lips.
Do not use a sun lamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

doxycycline may cause intracranial hypertension. This is more likely to occur in women of childbearing age who are overweight or have a history of intracranial hypertension. Tell your doctor right away if you have a headache, blurred vision, or changes in vision.

Contact your doctor immediately if fever, rash, joint pain, or tiredness occurs. These could be symptoms of an autoimmune syndrome where the body attacks itself.

You should not take antacids that contain aluminum, calcium or magnesium, or any product that contains iron such as vitamin or mineral supplements.

If you are using doxycycline to prevent malaria, take extra care not to get bitten by mosquitoes. Use protective clothing, mosquito netting or screens, and an insect repellent.

Before you have any medical tests, tell the medical doctor in charge that you are taking doxycycline. The results of some tests may be affected by doxycycline.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

doxycycline Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Incidence not known

abdominal or stomach tenderness
, tarry stools
bloating
clay-colored stools
cough
dark urine
decreased appetite
diarrhea
diarrhea, watery and severe, which may also be bloody
difficulty with swallowing
dizziness
fast heartbeat
feeling of discomfort
fever
headache
hives, itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
hives or welts, itching, or rash
increased thirst
inflammation of the joints
joint or muscle pain
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
nausea and vomiting
numbness or tingling of the face, hands, or feet
pain
redness and soreness of the eyes
redness of the skin
severe stomach pain
sore throat
sores in the mouth
stomach cramps
stomach pain or tenderness
swelling of the feet or lower legs
swollen lymph glands
tightness in the chest
unusual tiredness or weakness
unusual weight loss
yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

Back, leg, or stomach pains
bleeding gums
blood in the urine or stools
blurred vision
bulging soft spot on the head of an infant
change in the ability to see colors, especially blue or yellow
chest pain, discomfort, or burning
chills
cracks in the skin
decrease in vision
difficulty breathing
discoloration of the thyroid glands
double vision
general body swelling
heartburn
increased sensitivity of the skin to sunlight
loss of heat from the body
lower back or side pain
nosebleeds
pain or burning in the throat
pain with swallowing
painful or difficult urination
pale skin
pinpoint red spots on the skin
rash with flat lesions or small raised lesions on the skin
red, swollen skin
redness or other discoloration of the skin
redness, swelling, or soreness of the tongue
scaly skin
severe nausea
severe sunburn
sores, ulcers, or white spots on the lips or tongue or inside the mouth
unusual bleeding or bruising
vomiting blood

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

How to use doxycycline?

Usual Adult Dose for Bacterial Infection

Manufacturers' general recommendations:
IV:
Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
Maintenance dose: 100 to 200 mg IV per day, depending on the severity of the infection; 200 mg may be given in 1 or 2 infusions

Oral:
Initial dose: 200 mg orally on the first day, given in 2 or 4 divided doses
Maintenance dose: 100 mg orally per day, given once a day or in 2 divided doses
More severe infections: 100 mg orally every 12 hours

Approved indications:
-For the treatment of rickettsial infections, respiratory tract infections, ophthalmic infections, sexually transmitted infections, relapsing fever, plague, tularemia, cholera, Campylobacter fetus infections, brucellosis, bartonellosis, trachoma
-When bacteriological testing indicates appropriate susceptibility, for the treatment of infections due to Escherichia coli, Enterobacter aerogenes, Shigella species, Acinetobacter species, Haemophilus influenzae, Klebsiella species
-When penicillin is contraindicated, as alternative therapy for yaws, listeriosis, Vincent's infection, actinomycosis, Clostridium species infections
-As adjunctive therapy for acute intestinal amebiasis, severe acne

Usual Adult Dose for Acne

Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: As adjunctive therapy for severe acne

Some experts recommend:
Initial dose: 100 mg orally twice a day for 3 to 6 weeks or until improvement occurs
Maintenance dose: 50 to 150 mg orally once a day

Usual Adult Dose for Acne Rosacea

Oracea(R): 40 mg orally once a day in the morning on an empty stomach, preferably at least 1 hour prior to or 2 hours after meals

Comments:
-No meaningful effect shown for generalized erythema of rosacea.
-Safety and efficacy not established beyond 9 months and 16 weeks, respectively.

Approved indication: For the treatment of only inflammatory lesions (papules and pustules) of rosacea

Some experts recommend: 100 mg orally twice a day

Usual Adult Dose for Actinomycosis

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: When penicillin is contraindicated, as alternative therapy for actinomycosis due to Actinomyces israelii

Some experts recommend:
Penicillin-allergic patients: 100 mg orally or IV every 12 hours for as long as 6 to 12 months

Usual Adult Dose for Amebiasis

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: As an adjunct to amebicides in acute intestinal amebiasis

Some experts recommend: 100 mg orally twice a day as an adjunct to amebicides

Usual Adult Dose for Anthrax Prophylaxis

Postexposure prophylaxis: 100 mg orally or IV every 12 hours for 60 days after initial exposure

Comments:
-The Working Group on Civilian Biodefense has recommended doxycycline as an alternative agent to ciprofloxacin for postexposure anthrax prophylaxis after an intentional Bacillus anthracis release.

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

Usual Adult Dose for Cutaneous Bacillus anthracis

(Not approved by FDA)

Working Group on Civilian Biodefense recommendations: 100 mg orally or IV every 12 hours for 60 days after initial exposure

Comments:
-IV therapy with multiple drugs is recommended if there is evidence of systemic involvement or if head or neck lesions are present.
-Ciprofloxacin or doxycycline recommended for the treatment of cutaneous anthrax after an intentional B anthracis release.

Usual Adult Dose for Inhalation Bacillus anthracis

100 mg orally or IV every 12 hours
Total duration of therapy: 60 days

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics with activity against anthrax (e.g., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, ciprofloxacin, imipenem, clindamycin, or clarithromycin).

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]), to reduce the incidence or progression of disease following exposure to aerosolized B anthracis

Working Group on Civilian Biodefense Recommendations for Treatment of Anthrax Used as a Biological Weapon:
Contained casualty setting: 100 mg IV every 12 hours
Total duration of therapy: 60 days

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics.
-May switch to oral therapy when clinically appropriate
-Ciprofloxacin and doxycycline are recommended for the treatment of pulmonary anthrax in a contained casualty setting.

Mass casualty setting: 100 mg orally every 12 hours for 60 days

Comments:
-Doxycycline is recommended as an alternative to ciprofloxacin for the treatment of pulmonary anthrax in a mass casualty setting.

Usual Adult Dose for Bartonellosis

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of bartonellosis due to Bartonella bacilliformis

Some experts recommend: 100 mg orally or IV twice a day (in combination with rifampin 300 mg twice a day for severe disease)

Duration of therapy:
Mild to moderate disease: 10 to 14 days
Bacillary angiomatosis: 8 weeks
Neuroretinitis: 4 to 6 weeks
Osteomyelitis or peliosis hepatitis: 4 months

Usual Adult Dose for Upper Respiratory Tract Infection

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Comments:
-When used in streptococcal infections, duration of therapy should be 10 days.

Approved indications:
-For the treatment of respiratory tract infections due to Mycoplasma pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to Streptococcus pneumoniae

Some experts recommend: 100 mg orally every 12 hours for 7 to 10 days

Usual Adult Dose for Bronchitis

Usual Adult Dose for Brucellosis

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of brucellosis due to Brucella species (combined with streptomycin)

Some experts recommend: 100 mg orally twice a day for 6 weeks, in combination with gentamicin, streptomycin, or rifampin

Usual Adult Dose for Cervicitis

(Not approved by FDA)

CDC recommendations: 100 mg orally twice a day for 7 days

Comments:
-Doxycycline is recommended as presumptive therapy; concomitant treatment for gonococcal infection should be considered if incidence is high in patient population.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Chancroid

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Comments:
-The CDC recommends azithromycin, ceftriaxone, ciprofloxacin, or erythromycin; doxycycline is not a recommended agent.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: For the treatment of chancroid due to H ducreyi

Usual Adult Dose for Chlamydia Infection

Uncomplicated urethral, endocervical, or rectal infection: 100 mg orally twice a day for 7 days
Alternative for uncomplicated urethral or endocervical infection: 200 mg orally once a day for 7 days

Approved indications: For the treatment of uncomplicated urethral, endocervical, or rectal infections due to C trachomatis

CDC recommendations: 100 mg orally twice a day for 7 days

Comments:
-Single-dose azithromycin is recommended as the preferred agent if patient compliance is questionable.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Cholera

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of cholera due to Vibrio cholerae

Some experts recommend: 300 mg orally once, as an adjunct to fluid and electrolyte replacement

Usual Adult Dose for Epididymitis - Sexually Transmitted

100 mg orally twice a day for at least 10 days

Comments:
-The CDC recommends all patients receive ceftriaxone plus doxycycline for the initial treatment of epididymitis.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: For the treatment of acute epididymo-orchitis due to C trachomatis or Neisseria gonorrhoeae

Usual Adult Dose for Gastroenteritis

(Not approved by FDA)

Some experts recommend:
-Due to Listeria monocytogenes or Yersinia enterocolitica: 100 mg orally twice a day
-Due to Tropheryma whippelii: 100 mg orally twice a day for 1 year after initial 10- to 14-day therapy with penicillin G, streptomycin, or ceftriaxone

Usual Adult Dose for Gonococcal Infection - Uncomplicated

100 mg orally twice a day for 7 days

Alternate single visit dose: 300 mg orally initially followed in 1 hour by a second 300 mg dose

Comments:
-Not recommended for anorectal infections in men.

Approved indication: For the treatment of uncomplicated gonorrhea due to N gonorrhoeae

CDC recommendations: 100 mg orally twice a day for 7 days

Comments:
-The recommended regimen for uncomplicated infections of the cervix, urethra, rectum, or pharynx includes ceftriaxone plus (azithromycin [preferred] or doxycycline).
-If ceftriaxone is not available for uncomplicated infections of the cervix, urethra, or rectum, an alternative regimen includes cefixime plus (azithromycin [preferred] or doxycycline) plus test-of-cure in 1 week.
-Due to high tetracycline resistance among surveillance isolates, azithromycin is preferred as the second agent.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Granuloma Inguinale

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of granuloma inguinale due to Klebsiella granulomatis

CDC recommendations: 100 mg orally twice a day for at least 3 weeks and until all lesions have completely healed

Comments:
-An aminoglycoside (e.g., gentamicin) may be added if no improvement is observed after several days.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Inclusion Conjunctivitis

Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of inclusion conjunctivitis due to C trachomatis

Some experts recommend: 100 mg orally twice a day for 7 to 21 days

Usual Adult Dose for Lyme Disease - Arthritis

(Not approved by FDA)

Infectious Diseases Society of America (IDSA) recommendations: 100 mg orally every 12 hours for 28 days

Comments:
-Recommended for treatment of uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease

Usual Adult Dose for Lyme Disease - Carditis

(Not approved by FDA)

IDSA recommendations: 100 mg orally every 12 hours for 10 to 21 days

Comments:
-Recommended for patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease
-A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of hospitalized patients; an oral regimen should be used for completion of therapy and for outpatients.

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

(Not approved by FDA)

IDSA recommendations: 100 mg orally every 12 hours for 10 to 21 days

Comments:
-Recommended for treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent

Usual Adult Dose for Lyme Disease - Neurologic

(Not approved by FDA)

IDSA recommendations:
Lyme meningitis and other manifestations of early neurologic Lyme disease: 100 to 200 mg orally every 12 hours for 10 to 28 days

Comments:
-Recommended for patients intolerant of beta-lactam antibiotics with acute neurologic disease manifested by meningitis or radiculopathy

Usual Adult Dose for Lymphogranuloma Venereum

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indications: For the treatment of lymphogranuloma venereum due to C trachomatis

CDC recommendations: 100 mg orally twice a day for 21 days

Comments:
-Doxycycline is the preferred therapy.
-Patients should be clinically monitored until signs/symptoms have resolved.
-Prolonged therapy may be needed for HIV-infected patients; delay in symptom resolution may occur.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Malaria

(Not approved by FDA)

CDC recommendations:
Uncomplicated malaria due to chloroquine-resistant Plasmodium falciparum or P vivax: 100 mg orally twice a day for 7 days
Severe malaria: 100 mg orally or IV twice a day for 7 days

Comments:
-Doxycycline must be used with a fast-acting schizontocide (e.g., quinine); primaquine also required if treating P vivax or P ovale.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Malaria Prophylaxis

100 mg orally once a day

Comments:
-Prophylaxis should start 1 to 2 days before travel to endemic area; should continue daily while in malarious areas and for 4 weeks after leaving such areas.
-Doxycycline prophylaxis should not exceed 4 months.

Approved indication: For prophylaxis of malaria due to P falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

Usual Adult Dose for Melioidosis

(Not approved by FDA)

Some experts recommend: Doxycycline 100 mg orally twice a day plus chloramphenicol 10 mg/kg orally (not available in the US) 4 times a day plus sulfamethoxazole-trimethoprim 5 mg/kg (trimethoprim component) orally twice a day
Duration of therapy: Doxycycline and sulfamethoxazole-trimethoprim for 20 weeks; chloramphenicol for the first 8 weeks

Comments:
-This oral regimen may be initiated after the patient has received parenteral treatment with ceftazidime, imipenem, or meropenem for at least 10 days.

Usual Adult Dose for Nongonococcal Urethritis

100 mg orally twice a day for 7 days

Comments:
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: For the treatment of nongonococcal urethritis due to C trachomatis or Ureaplasma urealyticum

Usual Adult Dose for Pelvic Inflammatory Disease

(Not approved by FDA)

CDC recommendations:
Mild to moderately severe pelvic inflammatory disease (PID): 100 mg orally or IV every 12 hours
Duration of therapy: 14 days

Comments:
-A recommended parenteral regimen is (cefotetan or cefoxitin) plus doxycycline; an alternative parenteral regimen is ampicillin-sulbactam plus doxycycline.
-Parenteral therapy can be stopped 24 hours after clinical improvement but oral doxycycline should continue to complete 14 days of therapy; when tuboovarian abscess is present, metronidazole or clindamycin can be used with doxycycline for continued therapy (provides more effective anaerobic coverage than doxycycline alone).
-Recommended regimens for outpatient, oral therapy include (ceftriaxone or cefoxitin/probenecid or other parenteral third-generation cephalosporin) plus oral doxycycline with or without metronidazole.
-Current guidelines should be consulted for additional information.

Usual Adult Dose for Periodontitis

20 mg orally twice a day for up to 9 months

Comments:
-Should be taken at least 1 hour prior to or 2 hours after meals.
-Safety and efficacy not established beyond 12 months and 9 months, respectively.

Approved indication: As an adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in patients with periodontitis

Usual Adult Dose for Plague

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of plague due to Yersinia pestis

Some experts recommend: 100 mg orally or IV twice a day for 10 days

Working Group on Civilian Biodefense Recommendations for Treatment of Plague Used as a Biological Weapon:
Contained casualty setting: 100 mg IV twice a day or 200 mg IV once a day
Duration of therapy: 10 days (or until 2 days after fever subsides)

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Mass casualty setting:
Treatment: 100 mg orally twice a day for 10 days
Postexposure prophylaxis: 100 mg orally twice a day for 7 days

Comments:
-Doxycycline and ciprofloxacin are recommended as preferred agents for plague treatment or postexposure prophylaxis in a mass casualty setting.

Usual Adult Dose for Pleural Effusion

(Not approved by FDA)

Some experts recommend:
Sclerosing agent: Mix 500 mg of the powder for injection and 10 mL of lidocaine 1% in 50 mL of normal saline and inject into pleural space.

Comments:
-Clinical trials have reported use of doses ranging from 250 mg to 1 g.

Usual Adult Dose for Mycoplasma Pneumonia

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indications:
-For the treatment of respiratory tract infections due to Mycoplasma pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species

Some experts recommend: 100 mg orally or IV every 12 hours for 10 to 21 days

Usual Adult Dose for Pneumonia

Usual Adult Dose for Psittacosis

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of psittacosis (ornithosis) due to Chlamydophila psittaci

Some experts recommend: 100 mg orally twice a day for 7 to 10 days

Usual Adult Dose for Ornithosis

Usual Adult Dose for Proctitis

(Not approved by FDA)

CDC recommendations:
Sexually transmitted: 100 mg orally twice a day for 7 days

Comments:
-Doxycycline should be used in conjunction with ceftriaxone.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Enterocolitis

Usual Adult Dose for Rickettsial Infection

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indications: For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species

Some experts recommend:
-Rocky Mountain spotted fever, relapsing fever, or typhus: 100 mg orally or IV twice a day for 7 days
-Human monocytic or granulocytic ehrlichiosis: 100 mg orally or IV twice a day for 7 to 14 days

Usual Adult Dose for Skin or Soft Tissue Infection

(Not approved by FDA)

Some experts recommend:
Vibrio vulnificus: 100 mg orally or IV every 12 hours plus cefotaxime 2 g IV every 8 hours or ceftazidime 1 to 2 g IV every 8 hours

Usual Adult Dose for STD Prophylaxis

(Not approved by FDA)

CDC recommendations:
Prophylaxis after sexual assault: 100 mg orally twice a day for 7 days

Comments:
-Metronidazole plus (ceftriaxone or cefixime) plus (azithromycin or doxycycline) is the recommended empiric antimicrobial regimen for chlamydia, gonorrhea, and trichomonas.

Usual Adult Dose for Syphilis - Early

Early: 100 mg orally twice a day for 2 weeks
More than 1 year duration: 100 mg orally twice a day for 4 weeks
For the treatment of primary or secondary syphilis, some manufacturers recommend: 300 mg/day orally (in divided doses) or IV for at least 10 days

Comments:
-Penicillin is the drug of choice.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: When penicillin is contraindicated, as alternative therapy for syphilis due to Treponema pallidum

CDC recommendations:
Primary or secondary syphilis: 100 mg orally twice a day for 14 days
Late latent syphilis or latent syphilis of unknown duration: 100 mg orally twice a day for 28 days

Comments:
-Recommended for nonpregnant penicillin-allergic patients; penicillin-allergic pregnant patients should be desensitized and treated with benzathine penicillin.

Usual Adult Dose for Syphilis - Latent

Usual Adult Dose for Tertiary Syphilis

Usual Adult Dose for Trachoma

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Comments:
-The infectious agent is not always eliminated, as evaluated by immunofluorescence.

Approved indication: For the treatment of trachoma due to C trachomatis

Some experts recommend: 100 mg orally twice a day for 7 days

Usual Adult Dose for Tularemia

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: For the treatment of tularemia due to Francisella tularensis

Some experts recommend: 100 mg orally or IV twice a day for 14 to 21 days

Working Group on Civilian Biodefense Recommendations for Treatment of Tularemia Used as a Biological Weapon:
Contained casualty setting: 100 mg IV twice a day for at least 14 days

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, not available, or inactive in vitro.

Mass casualty setting:
Treatment: 100 mg orally twice a day for 14 to 21 days
Postexposure prophylaxis: 100 mg orally twice a day for 14 days

Comments:
-Doxycycline and ciprofloxacin are recommended as preferred agents for tularemia treatment and prophylaxis in a mass casualty setting.

Usual Adult Dose for Urinary Tract Infection

IV, Oral: Refer to Usual Adult Dose (Bacterial Infection) for manufacturers' general recommendations.

Approved indication: When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Some experts recommend:
Chronic: 100 mg orally every 12 hours

Usual Pediatric Dose for Bacterial Infection

Manufacturers' general recommendations for patients above 8 years of age:
IV:
45 kg or less:
Initial dose: 4.4 mg/kg IV on the first day, given in 1 or 2 infusions
Maintenance dose: 2.2 to 4.4 mg/kg IV per day, given in 1 or 2 infusions, depending on the severity of the infection

More than 45 kg:
Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
Maintenance dose: 100 to 200 mg IV per day, depending on the severity of the infection; 200 mg may be given in 1 or 2 infusions

Oral:
45 kg or less:
Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
Maintenance dose: 2.2 mg/kg orally per day, given once a day or in 2 divided doses
More severe infections: Up to 4.4 mg/kg orally per day

More than 45 kg:
Initial dose: 200 mg orally on the first day, given in 2 or 4 divided doses
Maintenance dose: 100 mg orally per day, given once a day or in 2 divided doses
More severe infections: 100 mg orally every 12 hours

Approved indications:
-For the treatment of rickettsial infections, respiratory tract infections, ophthalmic infections, sexually transmitted infections, relapsing fever, plague, tularemia, cholera, C fetus infections, brucellosis, bartonellosis, trachoma
-When bacteriological testing indicates appropriate susceptibility, for the treatment of infections due to E coli, E aerogenes, Shigella species, Acinetobacter species, H influenzae, Klebsiella species
-When penicillin is contraindicated, as alternative therapy for yaws, listeriosis, Vincent's infection, actinomycosis, Clostridium species infections
-As adjunctive therapy for acute intestinal amebiasis, severe acne

Usual Pediatric Dose for Acne

Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-As adjunctive therapy for severe acne
-For the treatment of inclusion conjunctivitis due to C trachomatis

Usual Pediatric Dose for Inclusion Conjunctivitis

Usual Pediatric Dose for Actinomycosis

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications:
-When penicillin is contraindicated, as alternative therapy for actinomycosis due to A israelii
-As an adjunct to amebicides in acute intestinal amebiasis
-For the treatment of bartonellosis due to B bacilliformis
-For the treatment of brucellosis due to Brucella species (combined with streptomycin)
-For the treatment of cholera due to V cholerae
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species
-For the treatment of psittacosis (ornithosis) due to C psittaci
-For the treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species
-When bacteriological testing indicates appropriate susceptibility, for the treatment of urinary tract infections due to Klebsiella species

Usual Pediatric Dose for Amebiasis

Usual Pediatric Dose for Brucellosis

Usual Pediatric Dose for Mycoplasma Pneumonia

Usual Pediatric Dose for Pneumonia

Usual Pediatric Dose for Rickettsial Infection

Usual Pediatric Dose for Urinary Tract Infection

Usual Pediatric Dose for Cholera

Usual Pediatric Dose for Psittacosis

Usual Pediatric Dose for Ornithosis

Usual Pediatric Dose for Bartonellosis

Usual Pediatric Dose for Anthrax Prophylaxis

Postexposure prophylaxis:
Less than 45 kg: 2.2 mg/kg orally or IV twice a day
45 kg or more: 100 mg orally or IV twice a day
Total duration of therapy: 60 days after exposure

Comments:
-The Working Group on Civilian Biodefense has suggested doxycycline as an alternative agent if ciprofloxacin is unavailable or contraindicated, for postexposure anthrax prophylaxis in a mass casualty setting after intentional release of B anthracis.
-If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. See below for directions.

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

Preparation of Emergency Doses from Tablets (if oral suspension not available):

1. Put a 100 mg doxycycline tablet into a small bowl and grind into a fine powder using the back of a metal teaspoon.

2. Mix the powder with 4 teaspoons of soft food or drink until the powder dissolves. Drinks work better than foods for dissolving the powder. The taste is generally acceptable when mixed in low-fat white milk, low-fat or regular chocolate milk, chocolate pudding, or apple juice mixed with sugar. Jellies, yogurt, and water do not hide the bitter taste of doxycycline. The mixture may be stored for up to 24 hours; after that, unused portions should be thrown away. Mixtures made with milk or pudding should be refrigerated.

3. Use measuring spoons, if available, to measure the correct dose of this mixture. If the child weighs:
12.5 lbs or less: Give one-half (1/2) teaspoon (12.5 mg doxycycline) twice a day
12.5 to 25 lbs: Give one (1) teaspoon (25 mg doxycycline) twice a day
25 to 37.5 lbs: Give one and one-half (1 1/2) teaspoons (37.5 mg doxycycline) twice a day
37.5 to 50 lbs: Give two (2) teaspoons (50 mg doxycycline) twice a day
50 to 62.5 lbs: Give two and one-half (2 1/2) teaspoons (62.5 mg doxycycline) twice a day
62.5 to 75 lbs: Give three (3) teaspoons (75 mg doxycycline) twice a day
75 to 87.5 lbs: Give three and one-half (3 1/2) teaspoons (87.5 mg doxycycline) twice a day
87.5 to 100 lbs: Give four (4) teaspoons (100 mg doxycycline) twice a day

Usual Pediatric Dose for Cutaneous Bacillus anthracis

(Not approved by FDA)

Working Group on Civilian Biodefense recommendations:
Less than 45 kg: 2.2 mg/kg orally every 12 hours for 60 days
45 kg or more: 100 mg orally every 12 hours for 60 days

Comments:
-IV therapy with multiple drugs is recommended if there is evidence of systemic involvement or if head or neck lesions are present.
-Ciprofloxacin or doxycycline recommended for the treatment of cutaneous anthrax after an intentional B anthracis release.
-If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. Refer to directions under Usual Pediatric Dose (Anthrax Prophylaxis).

Usual Pediatric Dose for Inhalation Bacillus anthracis

Less than 45 kg: 2.2 mg/kg orally or IV twice a day
45 kg or more: 100 mg orally or IV twice a day
Total duration of therapy: 60 days after exposure

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics with activity against anthrax (e.g., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, ciprofloxacin, imipenem, clindamycin, or clarithromycin).
-If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. Refer to directions under Usual Pediatric Dose (Anthrax Prophylaxis).

Approved indication: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

Working Group on Civilian Biodefense Recommendations for Treatment of Anthrax Used as a Biological Weapon:
Less than 8 years: 2.2 mg/kg (maximum 100 mg/dose) orally or IV every 12 hours
8 years or older and less than 45 kg: 2.2 mg/kg orally or IV every 12 hours
8 years or older and 45 kg or more: 100 mg orally or IV every 12 hours
Total duration of therapy: 60 days

Comments:
-Doxycycline should be given with 1 or 2 additional antibiotics.
-May switch to oral therapy when clinically appropriate
-Ciprofloxacin and doxycycline are recommended for the treatment of pulmonary anthrax after an intentional B anthracis release.

Usual Pediatric Dose for Upper Respiratory Tract Infection

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Comments:
-When used in streptococcal infections, duration of therapy should be 10 days.

Approved indications:
-For the treatment of respiratory tract infections due to M pneumoniae
-When bacteriological testing indicates appropriate susceptibility, for the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to S pneumoniae

Usual Pediatric Dose for Bronchitis

Usual Pediatric Dose for Cervicitis

(Not approved by FDA)

CDC recommendations for adolescents: 100 mg orally twice a day for 7 days

Comments:
-Doxycycline is recommended as presumptive therapy; concomitant treatment for gonococcal infection should be considered if incidence is high in patient population.
-The American Academy of Pediatrics (AAP) recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Chancroid

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Comments:
-The CDC recommends azithromycin, ceftriaxone, ciprofloxacin, or erythromycin; doxycycline is not a recommended agent.
-The patient's sexual partner(s) should also be evaluated/treated.

Approved indication: For the treatment of chancroid due to H ducreyi

Usual Pediatric Dose for Chlamydia Infection

Above 8 years of age and more than 45 kg:
Uncomplicated urethral, endocervical, or rectal infection: 100 mg orally every 12 hours for 7 days
Alternative for uncomplicated urethral or endocervical infection: 200 mg orally once a day for 7 days

Approved indications: For the treatment of uncomplicated urethral, endocervical, or rectal infections due to C trachomatis

CDC recommendations:
8 years or older: 100 mg orally twice a day for 7 days

Comments:
-Single-dose azithromycin is recommended as the preferred agent if patient compliance is questionable.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Epididymitis - Sexually Transmitted

(Not approved by FDA)

CDC recommendations for children weighing more than 45 kg and adolescents: 100 mg orally twice a day for 10 days

Comments:
-The CDC recommends all patients receive ceftriaxone plus doxycycline for the initial treatment of epididymitis.
-AAP recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

(Not approved by FDA)

CDC recommendations for children weighing more than 45 kg and adolescents: 100 mg orally twice a day for 7 days

Comments:
-The recommended regimen for uncomplicated infections of the cervix, urethra, rectum, or pharynx includes ceftriaxone plus (azithromycin [preferred] or doxycycline).
-If ceftriaxone is not available for uncomplicated infections of the cervix, urethra, or rectum, an alternative regimen includes cefixime plus (azithromycin [preferred] or doxycycline) plus test-of-cure in 1 week.
-Due to high tetracycline resistance among surveillance isolates, azithromycin is preferred as the second agent.
-The AAP recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Granuloma Inguinale

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indication: For the treatment of granuloma inguinale due to K granulomatis

CDC recommendations for adolescents: 100 mg orally twice a day for at least 3 weeks and until all lesions have completely healed

Comments:
-An aminoglycoside (e.g., gentamicin) may be added if no improvement is observed after several days.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Lyme Disease - Arthritis

(Not approved by FDA)

8 years or older:
IDSA recommendations: 2 mg/kg orally twice a day for 28 days
Maximum dose: 100 mg per dose

Comments:
-Recommended for treatment of uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease

Usual Pediatric Dose for Lyme Disease - Carditis

(Not approved by FDA)

8 years or older:
IDSA recommendations: 2 mg/kg orally twice a day for 10 to 21 days
Maximum dose: 100 mg per dose

Comments:
-Recommended for patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease
-A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of hospitalized patients; an oral regimen should be used for completion of therapy and for outpatients.

Usual Pediatric Dose for Lyme Disease - Erythema Chronicum Migrans

(Not approved by FDA)

8 years or older:
IDSA recommendations: 2 mg/kg orally twice a day for 10 to 21 days
Maximum dose: 100 mg per dose

Comments:
-Recommended for treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent

Some experts recommend: 1 to 2 mg/kg orally twice a day for 14 to 28 days
Maximum dose: 100 mg per dose

Usual Pediatric Dose for Lyme Disease - Neurologic

(Not approved by FDA)

8 years or older:
IDSA recommendations:
Lyme meningitis and other manifestations of early neurologic Lyme disease: 2 to 4 mg/kg orally twice a day for 10 to 28 days
Maximum dose: 100 to 200 mg per dose

Comments:
-Recommended for patients intolerant of beta-lactam antibiotics with acute neurologic disease manifested by meningitis or radiculopathy

Usual Pediatric Dose for Lymphogranuloma Venereum

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indications: For the treatment of lymphogranuloma venereum due to C trachomatis

CDC recommendations:
8 years or older: 100 mg orally twice a day for 21 days

Comments:
-Doxycycline is the preferred therapy.
-Patients should be clinically monitored until signs/symptoms have resolved.
-Prolonged therapy may be needed for HIV-infected patients; delay in symptom resolution may occur.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Malaria

(Not approved by FDA)

CDC recommendations:
Uncomplicated malaria due to chloroquine-resistant P falciparum or P vivax:
8 years or older: 2.2 mg/kg orally twice a day for 7 days
Maximum dose: 100 mg per dose

Severe malaria in patients 8 years or older:
Less than 45 kg: 2.2 mg/kg orally or IV twice a day
45 kg or more: 100 mg orally or IV twice a day
Duration of therapy: 7 days

Comments:
-Doxycycline must be used with a fast-acting schizontocide (e.g., quinine); primaquine also required if treating P vivax or P ovale.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Malaria Prophylaxis

8 years or older: 2 to 2.2 mg/kg orally once a day
Maximum dose: 100 mg per dose

Comments:
-Prophylaxis should start 1 to 2 days before travel to endemic area; should continue daily while in malarious areas and for 4 weeks after leaving such areas.
-Doxycycline prophylaxis should not exceed 4 months.

Approved indication: For prophylaxis of malaria due to P falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

Usual Pediatric Dose for Nongonococcal Urethritis

(Not approved by FDA)

CDC recommendations for adolescents: 100 mg orally twice a day for 7 days

Comments:
-The AAP recommends the same dose for patients 8 years or older and 45 kg or more.
-The patient's sexual partner(s) should also be evaluated/treated.

Usual Pediatric Dose for Pelvic Inflammatory Disease

(Not approved by FDA)

CDC recommendations for adolescents:
Mild to moderately severe PID: 100 mg orally or IV every 12 hours
Duration of therapy: 14 days

Comments:
-A recommended parenteral regimen is (cefotetan or cefoxitin) plus doxycycline; an alternative parenteral regimen is ampicillin-sulbactam plus doxycycline.
-Parenteral therapy can be stopped 24 hours after clinical improvement but oral doxycycline should continue to complete 14 days of therapy; when tuboovarian abscess is present, metronidazole or clindamycin can be used with doxycycline for continued therapy (provides more effective anaerobic coverage than doxycycline alone).
-Recommended regimens for outpatient, oral therapy include (ceftriaxone or cefoxitin/probenecid or other parenteral third-generation cephalosporin) plus oral doxycycline with or without metronidazole.
-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Plague

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indication: For the treatment of plague due to Y pestis

Working Group on Civilian Biodefense Recommendations for Treatment of Plague Used as a Biological Weapon:
8 years or older:
Contained casualty setting:
Less than 45 kg: 2.2 mg/kg IV twice a day (maximum 200 mg/day)
45 kg or more: 100 mg IV twice a day
Duration of therapy: 10 days (or until 2 days after fever subsides)

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Mass casualty setting:
Less than 45 kg: 2.2 mg/kg orally twice a day (maximum 200 mg/day)
45 kg or more: 100 mg orally twice a day

Duration of therapy:
Treatment: 10 days
Postexposure prophylaxis: 7 days

Comments:
-Doxycycline and ciprofloxacin are recommended as preferred agents for plague treatment or postexposure prophylaxis in a mass casualty setting.

Usual Pediatric Dose for STD Prophylaxis

(Not approved by FDA)

Prophylaxis after Sexual Assault:
AAP recommendations for patients 8 years or older and 45 kg or more: 100 mg orally twice a day for 7 days

Comments:
-Metronidazole plus (ceftriaxone or cefixime) plus (azithromycin or doxycycline [if at least 8 years of age]) is the recommended empiric antimicrobial regimen for patients at least 45 kg.

CDC recommendations for adolescents: 100 mg orally twice a day for 7 days

Comments:
-Metronidazole plus (ceftriaxone or cefixime) plus (azithromycin or doxycycline) is the recommended empiric antimicrobial regimen for chlamydia, gonorrhea, and trichomonas.

Usual Pediatric Dose for Trachoma

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Comments:
-The infectious agent is not always eliminated, as evaluated by immunofluorescence.

Approved indication: For the treatment of trachoma due to C trachomatis

Usual Pediatric Dose for Tularemia

IV, Oral: Refer to Usual Pediatric Dose (Bacterial Infection) for manufacturers' general recommendations for patients above 8 years of age.

Approved indication: For the treatment of tularemia due to F tularensis

Working Group on Civilian Biodefense Recommendations for Treatment of Tularemia Used as a Biological Weapon:
Contained casualty setting:
Less than 45 kg: 2.2 mg/kg IV twice a day (maximum 200 mg/day)
45 kg or more: 100 mg IV twice a day
Duration of therapy: At least 14 days

Comments:
-May switch to oral doxycycline when clinically indicated
-Doxycycline is recommended as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Mass casualty setting:
Less than 45 kg: 2.2 mg/kg orally twice a day (maximum 200 mg/day)
45 kg or more: 100 mg orally twice a day

Duration of therapy:
Treatment: 14 to 21 days
Postexposure prophylaxis: 14 days

Comments:
-Doxycycline and ciprofloxacin are recommended for tularemia treatment and prophylaxis in a mass casualty setting.

Renal Dose Adjustments

Most formulations: No adjustment recommended.
Oracea(R): May need to adjust dose; however, no specific guidelines have been suggested.

Liver Dose Adjustments

Data not available

Precautions

Consult WARNINGS section for dosing related precautions.

Dialysis

Dialysis does not alter serum half-life of doxycycline.

Other Comments

Administration advice:
-Avoid rapid administration of IV doxycycline; infusion duration may vary with dose, but is generally 1 to 4 hours; minimum infusion time recommended for 100 mg of a 0.5 mg/mL solution is 1 hour.
-Do not inject IV solutions IM or subcutaneously; caution recommended to avoid extravasation.
-IV doxycycline only recommended short-term when oral therapy is not indicated; the switch from IV to oral therapy should be made as soon as it is clinically feasible.
-Due to pain with IV infusion, doxycycline should be used orally when possible.
-Therapy should continue for at least 24 to 48 hours after symptoms/fever subside.
-Oral doxycycline should be taken with plenty of fluid in an upright position to reduce the risk of esophageal irritation and ulceration.
-Most oral doxycycline products should be taken with food or milk if gastric irritation occurs; absorption not significantly affected by food or milk.
-Oracea(R) and doxycycline hyclate 20 mg should be taken on an empty stomach, 1 hour before or 2 hours after a meal.

Storage requirements:
-The manufacturer's product information should be consulted.

Reconstitution/preparation techniques:
-The manufacturer's product information should be consulted.

IV compatibility:
-Data not available

General:
-Therapeutic antibacterial serum activity generally persists 24 hours following recommended dose.
-Absorption of tetracyclines impaired by iron-, zinc-, calcium-, aluminum-, or magnesium-containing products (e.g., antacids, sucralfate, mineral supplements, buffered didanosine).

Monitoring:
-General: Laboratory evaluations of organ system

What are the side effects of doxycycline?

What side effects can this medication cause?

Doxycycline may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

diarrhea
itching of the rectum or vagina
sore mouth

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

severe headache
blurred vision
skin rash
hives
difficulty breathing or swallowing
redness of the skin (sunburn)
yellowing of the skin or eyes
itching
dark-colored urine
light-colored bowel movements
loss of appetite
upset stomach
vomiting
stomach pain
extreme tiredness or weakness
confusion
decreased urination