Doxycycline Dosage

This dosage information may not include all the information needed to use Doxycycline safely and effectively. See additional information for Doxycycline.

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Usual Adult Dose for Acne

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

100 mg orally twice a day

Oracea (R) capsules: 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

Usual Adult Dose for Actinomycosis

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

Usual Adult Dose for Amebiasis

100 mg orally twice a day as an adjunct to amebicides

Usual Adult Dose for Anthrax Prophylaxis

Postexposure prophylaxis: 100 mg orally every 12 hours for 60 days following initial exposure
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.

Usual Adult Dose for Cutaneous Bacillus anthracis

100 mg orally every 12 hours for 60 days following initial exposure
IV therapy with multiple drugs is recommended if there is evidence of systemic involvement or if head or neck lesions are present.

The Working Group on Civilian Biodefense has recommended ciprofloxacin or doxycycline for the treatment of cutaneous anthrax after an intentional Bacillus anthracis release.

Usual Adult Dose for Inhalation Bacillus anthracis

100 mg orally or IV every 12 hours for a total of 60 days
One or two additional antibiotics with activity against anthrax should also be given (i.e., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, ciprofloxacin, imipenem, clindamycin, or clarithromycin). The switch from IV to oral therapy should be made as soon as it is clinically feasible.

Treatment for anthrax used as a biological weapon:

Contained-casualty setting: 100 mg IV every 12 hours plus one or two additional antibiotics; may switch to oral therapy when clinically appropriate, for total treatment duration of 60 days
The Working Group on Civilian Biodefense has recommended ciprofloxacin or doxycycline for the treatment of pulmonary anthrax in a contained-casualty setting.

Mass-casualty setting: 100 mg orally every 12 hours for 60 days
The Working Group on Civilian Biodefense has recommended doxycycline as an alternative to ciprofloxacin for the treatment of pulmonary anthrax in a mass-casualty setting.

Usual Adult Dose for Bartonellosis

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

Duration:
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

100 mg orally every 12 hours for 7 to 10 days

Usual Adult Dose for Bronchitis

100 mg orally every 12 hours for 7 to 10 days

Usual Adult Dose for Brucellosis

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

Usual Adult Dose for Chlamydia Infection

Urethral, endocervical, or rectal infection: 100 mg orally twice a day for 7 days

Single-dose azithromycin is the preferred agent if patient compliance is questionable.

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

Usual Adult Dose for Cholera

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 10 days, in conjunction with ceftriaxone

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

Usual Adult Dose for Gastroenteritis

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 Granuloma Inguinale

100 mg orally twice a day for at least 3 weeks or until all lesions have healed
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

100 mg orally twice a day for 7 to 21 days

Usual Adult Dose for Lyme Disease - Arthritis

100 mg orally every 12 hours for 14 to 28 days

Usual Adult Dose for Lyme Disease - Carditis

100 mg orally every 12 hours for 14 to 28 days

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

100 mg orally every 12 hours for 14 to 21 days

Usual Adult Dose for Lyme Disease - Neurologic

100 mg orally every 12 hours for 14 to 28 days

Usual Adult Dose for Lymphogranuloma Venereum

100 mg orally twice a day for 21 days or until symptoms have resolved; patients with HIV may require longer therapy

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

Usual Adult Dose for Malaria

Chloroquine-resistant Plasmodium falciparum and P vivax: 100 mg orally twice a day for 7 days plus quinine sulfate 650 mg every 8 hours for 3 to 7 days

Usual Adult Dose for Malaria Prophylaxis

Chloroquine-resistant areas: 100 mg orally once a day
Begin 1 to 2 days before travel to the malarious area. Continue daily during travel in the malarious area and for 4 weeks after leaving.

Usual Adult Dose for Melioidosis

Doxycycline 100 mg orally twice a day plus chloramphenicol 10 mg/kg orally (not available in the United States) 4 times a day plus sulfamethoxazole-trimethoprim 25 mg/kg - 5 mg/kg orally twice a day

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

Duration: Doxycycline and sulfamethoxazole-trimethoprim for 20 weeks; chloramphenicol for the first 8 weeks

Usual Adult Dose for Nongonococcal Urethritis

100 mg orally twice a day for 7 days

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

Usual Adult Dose for Periodontitis

20 mg orally twice a day for up to 9 months, as an adjunct to scaling and root planing

Usual Adult Dose for Pelvic Inflammatory Disease

100 mg orally or IV every 12 hours in combination with cefotetan, cefoxitin, or ceftriaxone, with or without metronidazole or clindamycin

Duration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Plague

100 mg orally or IV twice a day for 10 days

Treatment of plague used as a biological weapon:

Contained-casualty setting: 100 mg IV twice a day or 200 mg IV once a day for 10 days; may switch to oral doxycycline when clinically indicated
The Working Group on Civilian Biodefense has recommended doxycycline 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
The Working Group on Civilian Biodefense has recommended doxycycline or ciprofloxacin for plague treatment or postexposure prophylaxis in a mass-casualty setting.

Usual Adult Dose for Pleural Effusion

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

Usual Adult Dose for Mycoplasma Pneumonia

100 mg orally or IV every 12 hours for 10 to 21 days

Usual Adult Dose for Pneumonia

100 mg orally or IV every 12 hours for 10 to 21 days

Usual Adult Dose for Psittacosis

100 mg orally twice a day for 7 to 10 days

Usual Adult Dose for Ornithosis

100 mg orally twice a day for 7 to 10 days

Usual Adult Dose for Proctitis

Sexually transmitted: 100 mg orally twice a day, in conjunction with ceftriaxone

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

Usual Adult Dose for Enterocolitis

Sexually transmitted: 100 mg orally twice a day, in conjunction with ceftriaxone

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

Usual Adult Dose for Rickettsial Infection

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

Vibrio vulnificus: 100 mg IV or orally 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

Sexual assault victims: 100 mg orally twice a day for 7 days, in conjunction with metronidazole and ceftriaxone

Usual Adult Dose for Syphilis - Early

100 mg orally twice a day for 2 weeks (4 weeks if more than 1 year duration)

Some manufacturers recommend 300 mg/day orally or IV for at least 10 days for the treatment of primary or secondary syphilis.

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

Penicillin is the drug of choice. Penicillin-allergic or pregnant patients should be desensitized and treated with benzathine penicillin.

Usual Adult Dose for Syphilis - Latent

100 mg orally twice a day for 28 days

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

Penicillin is the drug of choice. Penicillin-allergic or pregnant patients should be desensitized and treated with benzathine penicillin.

Usual Adult Dose for Tertiary Syphilis

100 mg orally twice a day for 28 days

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

Penicillin is the drug of choice. Penicillin-allergic or pregnant patients should be desensitized and treated with benzathine penicillin.

Usual Adult Dose for Trachoma

100 mg orally twice a day for 7 days

Usual Adult Dose for Tularemia

100 mg orally or IV twice a day for 14 to 21 days

Treatment of tularemia used as a biological weapon:

Contained-casualty setting: 100 mg IV twice a day for 14 to 21 days; may switch to oral doxycycline when clinically indicated
The Working Group on Civilian Biodefense has recommended doxycycline or ciprofloxacin as an alternative to streptomycin and gentamicin if they are contraindicated, not available, or inactive in vitro.

Mass-casualty setting, treatment and postexposure prophylaxis: 100 mg orally twice a day for 14 days
The Working Group on Civilian Biodefense has recommended doxycycline or ciprofloxacin for tularemia treatment and prophylaxis in a mass-casualty setting.

Usual Adult Dose for Urinary Tract Infection

Chronic: 100 mg orally every 12 hours

Usual Pediatric Dose for Bacterial Infection

8 years or older:
45 kg or less:
Oral:
Initial dose: 4.4 mg/kg divided into 2 doses on the first day
Maintenance dose: 2.2 mg/kg/day, given once a day or in 2 divided doses; for more severe infections, up to 4.4 mg/kg may be used

IV:
Initial dose: 4.4 mg/kg on the first day, given in 1 or 2 infusions
Maintenance dose: 2.2 to 4.4 mg/kg, given in 1 or 2 infusions, depending on the nature and severity of the infection

Greater than 45 kg:
Oral:
Initial dose: 200 mg divided into 2 doses on the first day
Maintenance dose: 100 mg/day, given once a day or in 2 divided doses; for more severe infections, 100 mg every 12 hours is recommended

IV:
Initial dose: 200 mg on the first day, given in 1 or 2 infusions
Maintenance dose: 100 to 200 mg/day, depending on the nature and severity of the infection; 200 mg may be given in 1 or 2 infusions

Usual Pediatric Dose for Anthrax Prophylaxis

Treatment of anthrax used as a biological weapon:
7 years or less: 2.2 mg/kg (maximum 100 mg) orally or IV every 12 hours for 60 days following exposure
8 years or older and less than 45 kg: 2.2 mg/kg orally or IV every 12 hours for 60 days following exposure
8 years or older and 45 kg or more: 100 mg orally or IV every 12 hours for 60 days following exposure

The switch from IV to oral therapy should be made as soon as it is clinically feasible.

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 Bacillus anthracis.

If doxycycline oral suspension is not available, emergency doses may be prepared from tablets as follows:

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

Treatment of anthrax used as a biological weapon:
7 years or less: 2.2 mg/kg (maximum 100 mg) orally every 12 hours for 60 days
8 years or older and less than 45 kg: 2.2 mg/kg orally every 12 hours for 60 days
8 years or older and 45 kg or more: 100 mg orally every 12 hours for 60 days

IV therapy with multiple drugs is recommended if there is evidence of systemic involvement or if head or neck lesions are present. The switch from IV to oral therapy should be made as soon as it is clinically feasible.

The Working Group on Civilian Biodefense has recommended ciprofloxacin or doxycycline for the treatment of cutaneous anthrax after an intentional Bacillus anthracis release.

If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. Refer to directions under "Anthrax Prophylaxis" for pediatric patients.

Usual Pediatric Dose for Inhalation Bacillus anthracis

Treatment of anthrax used as a biological weapon:
Less than 8 years: 2.2 mg/kg (maximum 100 mg) orally or IV every 12 hours for 60 days
8 years or older and less than 45 kg: 2.2 mg/kg orally or IV every 12 hours for 60 days
8 years or older and 45 kg or more: 100 mg orally or IV every 12 hours for 60 days

One or two additional antibiotics with activity against anthrax should also be given (i.e., rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, ciprofloxacin, imipenem, clindamycin, or clarithromycin). The switch from IV to oral therapy should be made as soon as it is clinically feasible.

The Working Group on Civilian Biodefense has recommended ciprofloxacin or doxycycline for the treatment of pulmonary anthrax after an intentional Bacillus anthracis release.

If doxycycline oral suspension is not available, emergency doses may be prepared from tablets. Refer to directions under "Anthrax Prophylaxis" for pediatric patients.

Usual Pediatric Dose for Chlamydia Infection

8 years or older and 45 kg or more: 100 mg orally every 12 hours for 7 days

Single-dose azithromycin is the preferred agent.

Usual Pediatric Dose for Lyme Disease

8 years or older: 1 to 2 mg/kg (maximum 100 mg) orally twice a day for 14 to 28 days

Usual Pediatric Dose for Malaria

Chloroquine-resistant Plasmodium falciparum and P vivax:
8 years or older: 2 mg/kg (maximum 100 mg) orally twice a day for 7 days plus quinine sulfate 8.3 mg/kg every 8 hours for 3 to 7 days

Usual Pediatric Dose for Malaria Prophylaxis

Chloroquine-resistant areas:
8 years or older: 2 mg/kg orally (maximum 100 mg) once a day
Begin 1 to 2 days before travel to the malarious area. Continue daily during travel in the malarious area and for 4 weeks after leaving.

Usual Pediatric Dose for Plague

Treatment of plague used as a biological weapon:
Contained casualty setting:
Less than 45 kg: 2.2 mg/kg IV twice a day (maximum 200 mg/day) for 10 days; may switch to oral doxycycline when clinically indicated
45 kg or more: 100 mg IV twice a day for 10 days; may switch to oral doxycycline when clinically indicated

The Working Group on Civilian Biodefense has recommended doxycycline as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Mass casualty setting:
Treatment:
Less than 45 kg: 2.2 mg/kg orally twice a day (maximum 200 mg/day) for 10 days
45 kg or more: 100 mg orally twice a day for 10 days

Postexposure prophylaxis:
Less than 45 kg: 2.2 mg/kg orally twice a day (maximum 200 mg/day) for 7 days
45 kg or more: 100 mg orally twice a day for 7 days

The Working Group on Civilian Biodefense has recommended doxycycline or ciprofloxacin for plague treatment or postexposure prophylaxis in a mass-casualty setting.

Usual Pediatric Dose for Tularemia

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) for 14 to 21 days; may switch to oral doxycycline when clinically indicated
45 kg or more: 100 mg IV twice a day for 14 to 21 days; may switch to oral doxycycline when clinically indicated

The Working Group on Civilian Biodefense has recommended doxycycline as an alternative to streptomycin and gentamicin if they are contraindicated, unavailable, or inactive in vitro.

Mass casualty setting, treatment and postexposure prophylaxis:
Less than 45 kg: 2.2 mg/kg orally twice a day (maximum 200 mg/day) for 14 days
45 kg or more: 100 mg orally twice a day for 14 days

The Working Group on Civilian Biodefense has recommended doxycycline or ciprofloxacin for tularemia treatment or postexposure prophylaxis in a mass-casualty setting.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Accumulation of doxycycline may occur in patients with liver disease, particularly cholestatic liver disease. Consideration should be given to alternative agents in such patients. Close observation for evidence of toxicity, and dosage adjustments if necessary, may be appropriate for patients with liver disease if doxycycline must be given.

Precautions

Doxycycline, like other tetracycline-class antibiotics, can cause fetal harm when administered to a pregnant woman. If any tetracycline is used during pregnancy or if the patient becomes pregnant while taking these drugs, the patient should be informed of the potential hazard to the fetus and treatment stopped immediately. Tetracyclines should not be used in this age group, except for anthrax, including inhalational anthrax (postexposure) unless other drugs are not likely to be effective or are contraindicated.

All tetracyclines form a stable calcium complex in any bone-forming tissue. A decrease in fibula growth rate has been observed in premature human infants given oral tetracycline in doses of 25 mg/kg every 6 hours. This reaction was shown to be reversible when the drug was discontinued.

The use of drugs of the tetracycline class during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth. Tetracyclines, therefore, are not recommended for use in these stages of life unless other drugs are not likely to be effective, are contraindicated, or are unavailable.

Patients should be advised to avoid excessive sunlight or artificial ultraviolet light while receiving doxycycline and to discontinue therapy if phototoxicity occurs.

Accumulation of doxycycline may occur in patients with liver disease, particularly in patients with cholestatic liver disease. Consideration should be given to alternative agents. Close observation for evidence of toxicity (and dosage adjustments if necessary) may be appropriate for patients with liver disease if doxycycline must be given.

Certain oral liquid formulations may contain sodium metabisulfite, which may cause allergic or anaphylactic reactions in susceptible patients. Sulfite sensitivity is more frequent in patients with asthma.

Doxycycline may result in overgrowth of nonsusceptible microorganisms, including fungi. Superinfection with nonsusceptible organisms (i.e., yeasts) may occur with prolonged doxycycline therapy. If superinfection occurs, doxycycline should be discontinued and appropriate therapy instituted.

Oral doxycycline should be taken with a full glass of water in an upright position to help prevent esophageal ulceration and gastrointestinal irritation.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following tetracycline therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Renal, hepatic, and hematopoietic function should be monitored periodically during prolonged therapy. Tetracyclines may decrease plasma prothrombin activity and may increase BUN.

Decomposed tetracyclines may cause potentially fatal nephrotoxicity (Fanconi's syndrome); therefore, outdated or decomposed medications should be discarded.

Dialysis

Conventional hemodialysis does not alter serum half-life of doxycycline.

Other Comments

Oral doxycycline should be taken with plenty of fluid to reduce the risk of esophageal irritation and ulceration. Doses should be taken at least 4 hours before iron-, zinc-, calcium-, aluminum-, or magnesium-containing products (e.g., antacids, sucralfate, mineral supplements, buffered didanosine).

IV doxycycline should be infused slowly at a rate not to exceed 100 mg per hour.

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