Doxycycline

Brands

DEA Class; Rx

Common Brand Names; Vibramycin, Monodox, Acticlate, Atridox, Avidoxy, Doxy, Doxycin, Doryx, Oracea, Periostat, Adoxa, Ocudox, Doryx MPC

  • Tetracyclines

A tetracycline class agent derived from oxytetracycline. Used to treat acne vulgaris, non-gonococcal urethritis and cervicitis, exacerbations of bronchitis in patients with COPD, and acne vulgaris. Useful in patients with poor renal function. Also commonly used as adjunct to scaling and root planing for adult periodontitis.

Indicated for Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae

Indicated for treatment of Sexually Transmitted Infections

Lymphogranuloma venereum, uncomplicated urethral, endocervical or rectal infections caused by Chlamydia trachomatis

  • Uncomplicated urethral or endocervical infections

  • Rectal infections

Nongonococcal urethritis caused by Ureaplasma urealyticum

Granuloma inguinale caused by Klebsiella granulomatis

Post-exposure prophylaxis (PEP) (Off-label)

Syphilis caused by Treponema pallidum (when penicillin contraindicated)

Uncomplicated gonorrhea caused by Neisseria gonorrhoeae

Respiratory Tract Infections

  • Respiratory tract infections caused by Mycoplasma pneumoniae
  • Psittacosis (ornithosis) caused by Chlamydophila psittaci
  • Indicated for respiratory tract infections caused by the following microorganisms, when bacteriological testing indicates appropriate susceptibility to drug: Haemophilus influenzae, Klebsiella species, Streptococcus pneumoniae

Specific Bacterial Infections

  • Relapsing fever due to Borrelia recurrentis
  • Plague due to Yersinia pestis
  • Tularemia due to Francisella tularensis
  • Cholera caused by Vibrio cholerae
  • Campylobacter fetus infections caused by Campylobacter fetus
  • Brucellosis due to Brucella species (in conjunction with streptomycin)
  • Bartonellosis due to Bartonella bacilliformis
  • Gram negative microorganisms (eg, Escherichia coli, Enterobacter aerogenes, Shigella species, Acinetobacter species, urinary tract infections caused by Klebsiella species)

Indicated for trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated as judged by immunofluorescence

Indicated for anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure)

Indicated as adjunctive therapy for acute intestinal amebiasis

Indicated as adjunctive therapy for severe acne

Indicated for treatment of only inflammatory lesions (papules and pustules) of rosacea in adults

Indicated for prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (<4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

Documented hypersensitivity

  • Anorexia
  • Dental discoloration
  • Diarrhea
  • Dysphagia
  • Enterocolitis
  • Erythema multiform
  • Esophageal ulcer
  • Esophagitis
  • Exacerbation of systemic lupus erythematosus
  • Exfoliative dermatitis
  • Glossitis
  • Headache
  • Hemolytic anemia
  • Hepatotoxicity
  • Hypoglycemia
  • Inflammatory anogenital lesion
  • Intracranial hypertension
  • Nausea
  • Neutropenia
  • Pericarditis
  • Serum sickness
  • Skin hyperpigmentation
  • Toxic epidermal necrolysis
  • Thrombocytopenia
  • Upper abdominal pain
  • Urticaria
  • Vomiting
  • Drug rash with eosinophilia and systemic symptoms

Use of tetracyclines during tooth development (last half of pregnancy through age 8 years) can cause permanent discoloration of teeth; this adverse reaction is more common during long-term use but has been observed following repeated short-term courses; enamel hypoplasia has also been reported

Use doxycycline in pediatric patients 8 years of age or less only when potential benefits expected to outweigh risks in severe or life-threatening conditions (eg, anthrax, Rocky Mountain spotted fever); particularly when there are no alternative therapies

Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, and may range in severity from mild diarrhea to fatal colitis

Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines

May result in overgrowth of non-susceptible organisms, including fungi. If such infections occur, discontinue use and institute appropriate therapy

Severe skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) reported; if severe skin reactions occur, discontinue therapy immediately and institute appropriate therapy

Intracranial hypertension (pseudotumor cerebri) reported (rare) may occur; symptoms include headache, blurred vision, diplopia, and vision loss; papilledema can be found on funduscopy; women of childbearing age who are overweight or have a history of IH are at greater risk; possibility for permanent visual loss exists; if visual disturbance occurs during treatment, prompt ophthalmologic evaluation is warranted; intracranial pressure can remain elevated for weeks after drug cessation; monitor until they stabilize

All tetracyclines form a stable calcium complex in any bone-forming tissue; decrease in fibula growth rate has been observed in prematures given an oral tetracycline; reaction was shown to be reversible when the drug was discontinue

Antianabolic action of the tetracyclines may cause an increase in BUN; studies to date indicate that this does not occur with the use of doxycycline in patients with impaired renal function

Doxycycline offers substantial but not complete suppression of the asexual blood stages of Plasmodium strains

Prescribing doxycycline in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria

In long-term therapy, periodic laboratory evaluation of organ systems, including hematopoietic, perform renal and hepatic studies

Therapy may cause discoloration deciduous teeth, and reversible inhibition of bone growth when administered during second and third trimester of pregnancy, infancy, and childhood

Based on available published data, doxycycline is present in human milk; there are no data that inform about levels of doxycycline in breastmilk, effects on breastfed infant, or on milk production

Adults

Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 300 mg/day PO; 600 mg PO in a single physician’s visit for acute gonococcal infections.
Intravenous formulation: 300 mg/day IV.
Doryx MPC: 240 mg/day PO; 720 mg PO in a single physician’s visit for acute gonococcal infections.
Oracea or Periostat: 40 mg/day PO.

Geriatric

Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 300 mg/day PO; 600 mg PO in a single physician’s visit for acute gonococcal infections.
Intravenous formulation: 300 mg/day IV.
Doryx MPC: 240 mg/day PO; 720 mg PO in a single physician’s visit for acute gonococcal infections.
Oracea or Periostat: 40 mg PO/day.

Adolescents

45 kg or more:
Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 300 mg/day PO; 600 mg PO in a single physician’s visit for acute gonococcal infections.
Intravenous formulation: 300 mg/day IV.
Doryx MPC: 240 mg/day PO; 720 mg PO in a single physician’s visit for acute gonococcal infections.
 
Less than 45 kg:
Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 4.4 mg/kg/day PO.
Intravenous formulation: 4.4 mg/kg/day IV.
Doryx MPC: 5.3 mg/kg/day PO.

Children

8 years and older and 45 kg or more:
Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 300 mg/day PO; 600 mg PO in a single physician’s visit for acute gonococcal infections.
Intravenous formulation: 300 mg/day IV.
Doryx MPC: 240 mg/day PO; 720 mg PO in a single physician’s visit for acute gonococcal infections.
Oracea or Periostat: 40 mg PO/day.
8 years and older and less than 45 kg:
Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 4.4 mg/kg/day PO.
Intravenous formulation: 4.4 mg/kg/day IV.
Doryx MPC: 5.3 mg/kg/day PO.
1 to 7 years: Use generally not recommended; however, may be used for severe or life-threatening infections (e.g., anthrax, Rocky Mountain spotted fever).
Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 4.4 mg/kg/day PO.
Intravenous formulation: 4.4 mg/kg/day IV.
Doryx MPC: 5.3 mg/kg/day PO.

Infants

Use generally not recommended; however, doses up to 4.4 mg/kg/day PO/IV may be used for severe or life-threatening infections (e.g., anthrax, Rocky Mountain spotted fever).

Neonates

Use generally not recommended; however, doses up to 4.4 mg/kg/day PO/IV may be used for severe or life-threatening infections (e.g., anthrax, Rocky Mountain spotted fever).

Doxycycline

capsule

  • 50mg (Monodox, generic)
  • 75mg (Monodox)
  • 100mg (Monodox, Vibramycin, generic)
  • 150mg (Adoxa)

solution, reconstituted powder for IV

  • 100mg (Doxy, generic)

syrup

  • 50mg/5mL (Vibramycin)

oral suspension

  • 25mg/5mL (Vibramycin, generic)

tablet

  • 20mg (generic)
  • 50mg (Adoxa, generic)
  • 75mg (Acticlate, Adoxa, generic)
  • 100mg (Adoxa, generic)
  • 150mg (Acticlate, generic)

tablet, delayed-release

  • 50mg (Doryx)
  • 60mg (Doryx MPC)
  • 75mg (generic)
  • 100mg (generic)
  • 120mg (Doryx MPC)
  • 150mg (Doryx, generic)
  • 200mg (Doryx)

capsule, delayed-release

  • 40mg (Oracea, generic)

periodontal extended-release liquid

  • 10%
Drugs Generic
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