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doxycycline

Pronunciation

Generic Name: doxycycline (DOX i SYE kleen)
Brand Name: Adoxa, Alodox, Avidoxy, Doryx, Monodox, Morgidox, NicAzel Doxy 30, Ocudox Convenience Kit, Oracea, Oraxyl, Vibramycin, ...show all 24 brand names

What is doxycycline?

Doxycycline is a tetracycline antibiotic. It fights bacteria in the body.

Doxycycline is used to treat many different bacterial infections, such as urinary tract infections, acne, gonorrhea, and chlamydia, periodontitis (gum disease), and others.

Doxycycline is also used to treat blemishes, bumps, and acne-like lesions caused by rosacea. Doxycycline will not treat facial redness caused by rosacea.

Doxycycline may also be used for purposes not listed in this medication guide.

What is the most important information I should know about doxycycline?

You should not take this medicine if you are allergic to any tetracycline antibiotic.

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

Children should not use doxycycline. Doxycycline can cause permanent yellowing or graying of the teeth in children younger than 8 years old.

What should I discuss with my healthcare provider before taking doxycycline?

You should not take this medicine if you are allergic to doxycycline or to other tetracycline antibiotics such as demeclocycline, minocycline, tetracycline, or tigecycline.

To make sure doxycycline is safe for you, tell your doctor if you have:

  • liver disease;

  • kidney disease;

  • asthma or sulfite allergy;

  • a history of increased pressure inside your skull; or

  • if you take isotretinoin (Amnesteem, Claravis, Sotret).

If you are using doxycycline to treat gonorrhea, your doctor may test you to make sure you do not also have syphilis, another sexually transmitted disease.

FDA pregnancy category D. Do not use doxycycline if you are pregnant. It could harm the unborn baby or cause permanent tooth discoloration later in life. Tell your doctor right away if you become pregnant during treatment.

Doxycycline can make birth control pills less effective. Ask your doctor about using a non hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while using doxycycline.

Doxycycline passes into breast milk and may affect bone and tooth development in a nursing baby. You should not breast-feed while you are taking doxycycline.

Children should not use doxycycline. Doxycycline can cause permanent yellowing or graying of the teeth in children younger than 8 years old.

How should I take doxycycline?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take doxycycline with a full glass of water. Drink plenty of liquids while you are taking doxycycline.

Different brands of doxycycline may have different instructions about taking them with or without food.

Most brands of doxycyline may be taken with food or milk if the medicine upsets your stomach.

Take Oracea or Periostat on an empty stomach, at least 1 hour before or 2 hours after a meal.

You may open a Doryx capsule or break up a Doryx tablet and sprinkle the medicine into a spoonful of applesauce to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Drink a full glass (8 ounces) of cool water right away.

Do not crush, break, or open a delayed-release capsule or tablet. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time. The enteric coated pill has a special coating to protect your stomach. Breaking the pill will damage this coating.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Doxycycline will not treat a viral infection such as the flu or a common cold.

If you need surgery, tell the surgeon ahead of time that you are using doxycycline. You may need to stop using the medicine for a short time.

Store at room temperature away from moisture and heat.

Throw away any unused medicine after the expiration date on the label has passed. Using expired doxycycline can cause damage to your kidneys.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, and diarrhea.

What should I avoid while taking doxycycline?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking doxycycline and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Avoid exposure to sunlight or tanning beds. Doxycycline can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking doxycycline.

Doxycycline side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • changes in your vision;

  • diarrhea that is watery or bloody;

  • fever, swollen glands, body aches, flu symptoms, weakness;

  • skin rash, pale skin, easy bruising or bleeding, severe tingling, numbness, pain, muscle weakness;

  • upper stomach pain (may spread to your back), loss of appetite, dark urine, jaundice (yellowing of the skin or eyes);

  • chest pain, irregular heart rhythm, feeling short of breath;

  • confusion, nausea and vomiting, swelling, rapid weight gain, little or no urinating;

  • new or worsening cough with fever, trouble breathing;

  • increased pressure inside the skull--severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • upset stomach;

  • mild nausea, mild diarrhea;

  • mild skin rash or itching; or

  • vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Doxycycline dosing information

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:

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 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:

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 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:

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 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:

(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 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:

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 Tertiary Syphilis:

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 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:

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 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:

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 Brucellosis:

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 Mycoplasma Pneumonia:

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 Pneumonia:

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 Rickettsial Infection:

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 Urinary Tract Infection:

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 Cholera:

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 Psittacosis:

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 Ornithosis:

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 Bartonellosis:

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 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:

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 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.

What other drugs will affect doxycycline?

Other drugs may interact with doxycycline, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about doxycycline.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
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