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Doxycycline
Paul A. Pham Pharm.D. and John G. Bartlett M.D.
03-19-2008
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Available formulation in Zambia: Capsule or tablet: 100 mg (hydrochloride).
- High rates of V. cholerae resistance
- Drug of choice for brucellosis, chlamydia, and tick-borne infections.
- Brucellosis: doxycycline 100 mg PO q12h x 6 wks PLUS rifampicin 7.5 mg/kg q12h x 6 wks OR streptomycin 1gm IM q24h x 3 weeks (preferred regimen for osteo-articular or cardiac involvement)
- Tick-borne infection due to R. conorii and R. africae: doxycycline 100 mg q12h x 7 days
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P. falciparum malaria (2nd line): doxycycline 200 mg x 1, then 100-200 mg daily x 7 d PLUS quinine.
- STDs in men and non-pregnant women: doxycycline 100 mg bid x 7 days for pt and female partner PLUS ciprofloxacin 500 mg x1. Metronidazole 2000 mg x1 should also be given to female partner.
- Chlamydia: doxycycline 100 mg bid x 7 days (first line).
- LVG: doxycycline 100 mg bid x 14 days (first line).
- Tick-bite fever (rickettsial disease): doxycycline 200 mg x 1, then 100 mg bid x 7 d
- Significant drug-drug interactions with PIs and NNRTIs are unlikely.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Anthrax due to Bacillus anthracis, including inhalation anthrax (post-exposure). CDC recommends as first line agent + 1-2 additional agents with in vitro activity (for inhalation anthrax, see "biodefense-anthrax")
- Granuloma inguinale caused by Calymmatobacterium granulomatis
- Lymphogranuloma venereum caused by chlamydia spp
- Psittacosis caused by Chlamydia psitta
- Q fever
- Rickettsialpox
- Rocky mountain spotted fever
- Typhus infections
- Nongonococcal urethritis
- Yaws caused by T. pertenue; Mycoplasma pneumoniae; trachoma; inclusion conjunctivitis cause by C. trachomatis.
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
|
Vibramycin
| Doxycycline | Pfizer | oral
suspension
25mg/5ml | $1.20 per 5ml |
|
|
|
| oral
capsule
50mg; 100mg | $2.50 |
|
|
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| oral
syrup
50mg/5ml | $2.20 per 5ml |
| Doxycycline; Monodox; Adoxa | Doxycycline | Generic manufacturers (Imiren, Watson/Schein and others) | oral
capsule
50mg; 100mg | $1.00 |
|
|
|
| IV
vial
100mg | $14.75 |
|
|
|
| oral
tablet
50mg; 75mg; 100mg | $1.15 |
| Periostat | Doxycycline | Collagenex Pharmaceutical and generic manufacturer (Mutual pharmaceutical) | Oral
20mg
caps | $1.32 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
Usual dose
Usual dose
Usual dose
Usual dose
Usual dose
Usual dose
- GI intolerance (dose related)
- Stains and deforms teeth in children up to 8 yrs old
- Photosensitivity
- Candida overgrowth (vaginitis and esophagitis)
- Worsening azotemia in pts with renal failure
- Rash
- "Black tongue" syndrome; benign fungus infection that is generally reversible upon drug discontinuation.
- Esophageal ulceration
- Elevated liver function tests
- Jarisch-Herxheimer reaction
- Digoxin - may result in increased digoxin concentration (in about 10% of pts).Monitor serum level with sign and symptoms of digoxin toxicity.
- Penicillins - in vitro antagonism when co-administered. Bacteriocidal effect of penicillins may be diminished in vivo. Avoid co-administration.
- Urinary alkalinizers (sodium lactate, sodium bicarbonate) - increased urinary excretion of tetracyclines by 24-65%. Avoid co-administration.
- Polyvalent metal cations (aluminum, zinc, magnesium, iron, calcium [milk]) - polyvalent metal cations form an insoluble chelate with tetracyclines resulting in decreased absorption and serum levels of tetracyclines. Separate administration by 4 hrs
- Bismuth salts (bismuth subsalicylate-pepto-bismol) - bismuth salts chelate tetracyclines resulting in a decreased absorption of tetracycline. Administer bismuth 2 hrs after tetracycline.
- Warfarin-may increase INR. Monitor INR closely.
- Carbamazepine, phenytoin, phenobarbital, rifampin, rifabutin -may decrease doxycycline serum levels. Avoid rifampin co-administration. Monitor closely for doxycycline therapeutic failure.
- Methoxyflurane: case reports of renal failure with co-administration with tetracycline. Avoid co-administration.
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ddI (buffer in peds formulation) contains cations - polyvalent metal cations form an insoluble chelate with tetracyclines resulting in decreased absorption and serum levels of tetracyclines. Separate administration by 4 hrs.
Doxycycline also has activity against plasmodium (malaria), rickettsial and brucella spp.
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S. pneumoniae: 12 and 27% resistance in bloodstream infection and pneumonia, respectively. Cross-resistance with PCN-resistant S. pneumoniae with only 60% susceptible.
- Some strains of CA-MRSA are sensitive doxycycline, but minocycline should be used due to better in vitro activity and demonstrated efficacy in vivo.
Preferred tetracycline derivative due to more convenient BID dosing regimen and no food-drug interaction. Recommended tetracycline derivative in pts with renal failure. Agents of choice for rickettsial and vibrio infections.
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