Doxycycline (Vibramycin)

Category:

  • Antibiotic

Description:

  • Tetracycline antibiotic

Indications:

  • Rickettsiae infections (Rocky Mtn spotted fever, typhus fever, Q fever, rickettsialpox and tick fevers)

  • Mycoplasma pneumoniae infections

  • Psittacosis and ornithosis

  • Lymphogranuloma venereum and granuloma inguinale

  • Borrelia recurrentis infections

  • Gram-negative infections (E. coli, Enterobacter aerogenes, Shigella species, Acinetobacter calcoaceticus, H. influenzae, Klebsiella species,H. ducreyi, Yersinia pestis, Francisella tularensis, Bartonella bacilliformis, Bacteroides species, Campylobacter fetus, V. cholerae, Brucella species)

  • Gram-positive infections (Streptococcus species, S. pyogenes, S. faecalis)

  • For infections were penicillin is the drug-of-choice but is contraindicated (N. gonorrhoeae, Treponema pallidum, T. pertenue, Listeria monocytogenes, Clostridium species, Bacillus anthracis, Fusobacterium fusiforme, Actinomyces species,  N. meningitidis)

  • Acute intestinal amebiasis

  • Uncomplicated gonococcal infections (N. gonorrhoeae, C. trachomatis, Ureaplasma urealyticum)

  • Lyme disease (Borrelia burgdorferi)

  • Travelerís diarrhea (E.coli)

  • Rape victim prophylaxis

Contraindications:

  • None

Precautions:

  • Pregnancy category D

  • Do not use in last half of pregnancy up to 8 years old due to tooth discoloration

  • May cause photosensitivity reactions

  • Prolonged intraveneous (IV) administration may lead to thrombophlebitis, initiate oral therapy as soon as possible

  • Doses greater than 2 grams per day may lead to hepatic function impairment

Excreted in breast milk

  • May cause pseudotumor cerebri (benign intracranial hypertension with symptoms of headache and blurred vision)

  • Do not use after expiration date.  Degraded, expired tetracyclines are highly nephrotoxic.

  • May be taken with food or milk.

  • Take with a full glass of water and remain standing for at least 90 seconds and/or lay down for 60 minutes to decrease occurrence of esophageal ulcers.

  • Complete full course of therapy.

Adverse Reactions (Side Effects):

  • Anorexia, nausea, vomiting, diarrhea, epigastric distress, loose stools, sore throat

  • Esophageal ulcers

  • Fatty liver, hepatotoxicity, increased BUN levels

  • Urticaria

  • Local injection site pain

Dosage:

Administered orally (capsules and suspension) and by IV injection

  • Adults (Children >8 years old or >45kg):

    • Oral:

      • Mild/moderate infections: 100mg po qd

      • Severe infections: 100mg po bid

    • Parenteral (IV only): 100-200mg per day, in 1 to 2 infusions per day

  • Children (>8 years old and <45kg):

    • Oral: 4.4mg/kg/day in 2 equal doses on first day then 2.2mg/kg/day in 1-2 doses up to 4.4

    • Parenteral: 2.2-4.4mg/kg/day (average 12mg/kg/day) in 2 divided doses

  • Acute gonorrhea: 

    • 200mg initially and 100mg at bedtime on first day , then 100mg q12h for 3 days or one-site visit of 300mg initial, followed by 300mg in 1 hour

  • Primary and Secondary syphilis: 

    • 300mg/day in divided doses for at least 10 days

  • Travelerís diarrhea prophylaxis: 

    • 100mg a day

  • Endometriosis, salpingitis, parametritis, peritonitis: 

    • 100mg IV bid, with cefoxitin 2 grams IV qid

  • Chlamydia trachomatis

    • 100mg bid for 7 days

  • Rape victim prophylaxis: 

    • 100mg bid for 7 days

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