Adult Dosing
Bacterial infections
- 200 mg IV on day 1 divided q12-24 hrs
- Then 100-200 mg IV divided q12-24 hrs, depending upon the severity of infection
Primary/secondary syphilis
- 300 mg/day IV for at least 10 days
Inhalation anthrax (post-exposure)
- 100 mg IV q12 hrs. Switch to 100 mg PO bid when clinically appropriate for a total of 60 days
- Add 1 or 2 other anti-infectives, depending on clinical situation
Malaria [Non FDA-Approved]
- 100 mg IV q12 hrs and then switch to oral doxycycline x 7 days
Pediatric Dosing
Bacterial infections
Child >8 yrs
- <45 kgs (<100 lbs): 4.4 mg/kg/day IV on day 1 divided q12-24 hrs; then 2.2-4.4 mg/kg/day IV divided q12-24 hrs, depending upon the severity of infection. [Max: 200 mg/day]
- >45 kgs (>100 lbs): Use usual adult dose
Inhalation anthrax
Child >8 yrs
- <45 kgs (<100 lbs): 4.4 mg/kg/day IV divided q12 hrs. Switch to 4.4 mg/kg/day PO divided bid when clinically appropriate for a total of 60 days. [Max: 200 mg/day]
- >45 kgs (>100 lbs): Use usual adult dose
Malaria [Non FDA-Approved]
- Children <45 kg: 2.2 mg/kg IV q12 hrs. Switch to oral medication when tolerated
- Children >45 kg: Same as adult dosage
[Outline]
- Recommended minimum infusion time for 100 mg of a 0.5 mg/ml solution is one hour
- Parenteral products should be inspected for visual particulate matter and discoloration
- Parenteral therapy is only indicated when oral therapy is not possible/feasible. Switch to oral route as soon as possible
- Doxycycline is not the drug of choice for any type of staphylococcal infections
- Culture and susceptibility tests should be performed to determine the causative organism and its susceptibility to the drug
- Use of tetracyclines, including doxycycline, during tooth development (last half of pregnancy, infancy and childhood till the age of 8 yrs) may cause permanent discoloration of teeth. Hence it should not be used in this age group, unless treating inhalation anthrax or if other drugs are not effective or are contraindicated
- Use of this drug may result in overgrowth of nonsusceptible organisms particularly fungi. Institute appropriate therapy if new infections develop
- Tetracyclines can cause photosensitivity; avoid exposure to sunlight
- Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines. Avoid exposure to sunlight or ultraviolet light
- Use with caution in pre-existing hepatic impairment. Doses >2 g/day associated with liver failure. Monitor LFTS and avoid other hepatotoxic drugs
- Prolonged IV use may result in thrombophlebitis. Institute oral therapy whenever reasonable
- Bulging fontanels in infants and benign intracranial hypertension in adults have been reported in individuals receiving tetracyclines
- Doxycycline may decrease efficacy of oral contraceptives
- Measure BUN, serum creatinine, CBC at baseline and LFTs if prolonged therapy
- Use with methoxyflurane reported to result in fatal renal toxicity
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- SLE
- Geriatric population
- Pediatric population <8 yrs
- Lactation
Doxy 100, Doxy 200 interacts with :
Pregnancy Category:D
Breastfeeding: Most sources consider that tetracyclines are contraindicated during breastfeeding due to possible staining of infants' dental enamel or bone deposition. However short term use of tetracyclines would not adversely affect the breastfed infant. Avoid prolonged or repeated courses of therapy during nursing. Monitor the infant for adverse events such as rash, diarrhea or candidiasis. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 20 July 2010).
