Acticlate, Vibramycin, Doxy, Doryx, Monodox, Oracea, many others, and generics
Antibiotic, tetracycline derivative

D	2	Yes	Yes	No
Key

• Caps: 50, 75, 100, 150 mg
• Tabs (Acticlate and generics): 20, 50, 75, 100, 150 mg
• Delayed release caps (Oracea and generics): 40 mg
• Delayed release tabs (Doryx and generics): 50, 75, 80, 100, 150, 200 mg
• Syrup: 50 mg/5 mL (473 mL); contains parabens and propylene glycol
• Oral suspension: 25 mg/5 mL (60 mL)
• Injection (Doxy and generics): 100 mg

Dosing

• General dosing, Lyme disease, rickettsial disease, Rocky Mountain spotted fever, and skin/soft tissue infection (see remarks) :
  • ≤45 kg: 2.2 mg/kg/dose BID PO/IV; max. dose: 200 mg/24 hr
  • >45 kg: 100 mg/dose BID PO/IV
  • Max. dose: 200 mg/24 hr
• PID (see latest CDC STI treatment guidelines):
  • Inpatient: 100 mg IV Q12 hr with cefotetan or cefoxitin, or ceftriaxone + metronidazole. Convert to oral therapy 24 hr after patient improves on IV to complete a 14-day total course (IV and PO).
  • Outpatient: 100 mg PO Q12 hr × 14 days with ceftriaxone single IM dose with metronidazole, or cefoxitin single IM dose + probenecid single PO dose with metronidazole, or other parenteral third-generation cephalosporin with metronidazole
• Anthrax (inhalation/systemic/cutaneous; see remarks): Initiate therapy with IV route and convert to PO route when clinically appropriate. Duration of therapy is 60 days (IV and PO combined):
  • ≤8 yr or ≤45 kg: 2.2 mg/kg/dose BID IV/PO; max. dose: 200 mg/24 hr
  • >8 yr and >45 kg: 100 mg/dose BID IV/PO
• Malaria prophylaxis (start 1–2 days prior to exposure and continue for 4 wk after leaving endemic area):
  • ≥8 yr: 2.2 mg/kg/24 hr PO once daily; max. dose: 100 mg/24 hr and max. duration of 4 mo
  • Adult: 100 mg PO once daily
• Acne:
  • ≥8 yr and adolescent: 50-100 mg BID PO or 150 mg once daily PO
• Periodontitis:
  • Adult: 20 mg BID PO × ≤9 mo

Notes

• Use with caution in hepatic and renal disease. Generally not recommended for use in children <8 yr due to risk for tooth enamel hypoplasia and discoloration. However, the AAP Red Book recommends doxycycline as the drug of choice for rickettsial disease regardless of age and the use in children <8 yr for short treatment courses (≤21 days). May cause GI symptoms, photosensitivity, hemolytic anemia, rash, and hypersensitivity reactions. Increased intracranial pressure (pseudotumor cerebri), TEN, DRESS, erythema multiforme, and Stevens-Johnson syndrome have been reported.
• Doxycycline is approved for the treatment of anthrax (Bacillus anthracis) in combination with one or two other antimicrobials. If meningitis is suspected, consider using an alternative agent because of poor CNS penetration. Consider changing to high-dose amoxicillin (25–35 mg/kg/dose TID PO) for penicillin-susceptible strains. See www.cdc.gov/anthrax/treatment/index.html for the latest information.
• Rifampin, barbiturates, phenytoin, and carbamazepine may increase clearance of doxycycline. Doxycycline may enhance the hypoprothrombinemic effect of warfarin. See Tetracycline for additional drug/food interactions and remarks.
• Infuse IV over 1–4 hr. Avoid prolonged exposure to direct sunlight.
• For periodontitis, take tablets ≥1 hr prior to or 2 hr after meals.