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doxycycline (Vibramycin, Doryx, Periostat, Oracea)

Tradenames: Vibramycin, Doryx. Indications: 1) bacterial infections caused by susceptible bacteria, including mycoplasma & chlamydia, spirochetes, rickettsiae & some protozoa - tularemia, brucellosis, listeriosis, actinomycosis, psittacosis, trachoma [11] - rickettsial infection - typhus endemic typhus, scrub typhus, Brill-Zinsser disease - Rocky Mountain spotted fever - Bartonella infection - ehrlichiosis - rickettsialpox - other tick borne-infection - borreliosis, Lyme disease - anthrax, cutaneous anthrax, inhalation anthrax [11] - upper respiratory tract infecton - pharyngitis, sinusitis - lower respiratory tract infection - bronchitis, pneumonia - oral cavity infection - gingivostomatitis, periodontitis - gastrointestinal infection - cholera, enterocoloitis, proctitis [11] - urogenital infection - syphilis, uncomplicated gonorrhea orchitis, chanchroid, lymphogranuloma venereum, donovanosis, yaws - treatment of non gonococcal urethritis caused by Chlamydia trachomatis & Ureaplasma urealyticum - skin or soft tissue infection - moderately severe inflammmatory acne [12] - rosacea (Oracea) - mycobacterial infection [11] - anoplura (lice) - malaria - leptosopirosis - eye infection - inclusion conjnctivitis [11] 2) prevention of "Traveler's Diarrhea" caused by E. coli 3) prevention of plague [11] 4) pleural effusion: used as a sclerosing agent in pleurodesis 5) investigational use as disease-modifying antirheumatic agent 6) investigational use in osteoarthritis [9] Contraindications: - not for use by children < 12 years of age - pregnancy category: D Dosage: - 200 mg IV/PO loading dose, then 50-100 mg every 12 hours - take oral dose on empty stomach Tabs: 50, 100 mg Syrup: 25 & 50 mg/5 mL Periostat: (doxycycline hyclate): 20 mg PO BID Oracea: 40 mg/day (anti-inflammatory, but NOT antibacterial) [10] Pharmacokinetics: 1) well distributed to most tissues, including CSF 2) protein-binding 90% 3) not metabolized, partially inactivated in GI tract 4) elimination a) 1/2life is 16 hours with normal renal function b) slightly prolonged with severe renal insufficiency c) 23-41% excreted unchanged into the urine, d) 30-59% excreted unchanged in the feces 5) no dose adjustment necessary with renal failure Antimicrobial activity: Gram positive - Streptococcus - Streptococcus group A (+/-) - Streptococcus group B (+/-) - Streptococcus group C (+/-) - Streptococcus group G (+/-) - Streptococcus pneumonia - Staphylococcus aureus (MSSA) (+/-) - Staphylococcus aureus (MRSA) (+/-) - Enterococcus (Vancomycin-resistant, some) Gram negative - Neisseria gonorrhoeae (+/-) - Moraxella catarrhalis - Haemophilus influenzae - Aeromonas - Escherichia coli (+/-) - Yersinia enterocolitica - Francisella tularensis - Brucella species - Vibrio vulnificus Atypical bacteria - Chlamydia species - Mycoplasma pneumonia - Rickettsia Anaerobes - Actinomyces - Bacteroides fragilis (+/-) - Bacteroides melaninogenicus - Clostridium species Adverse effects: 1) nausea/vomiting 2) erosive pill esophagitis (1-10%) 3) phototoxicity, dose-related (less than with tetracycline) 4) tooth deposition (less than with tetracycline) 5) phlebitis with frequent IV administration 6) dyspepsia, abdominal cramps 7) loss of appetite 8) neutropenia 9) eosinophilia 10) hepatotoxicity 11) rash 12) diarrhea 13) vaginal yeast infection 14) 2-fold increased risk of miscarriage [13] 15) increased intracranial pressure (pseudotumor cerebri) [12] Drug interactions: (see tetracycline) Mechanism of action: 1) bacteriostatic 2) inhibits bacterial protein synthesis 3) inhibits collagenase [9]

Interactions

drug interactions

Related

gonorrhea pleurodesis; chemical pleurodesis Rickettsia Spirochaetaceae traveler's diarrhea urethritis

General

sclerosing agent tetracycline (Achromycin, Sumycin, Bristacycline)

Properties

MISC-INFO: elimination route LIVER KIDNEY protein-binding 90% pregnancy-category D safety in lactation -

Database Correlations

PUBCHEM correlations

References

  1. Geriatric Dosage Handbook, 6th edition, Selma et al eds, Lexi-Comp, Cleveland, 2001
  2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 164
  3. Sanford Guide to antimicrobial therapy 1997
  4. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  5. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  6. Prescriber's Letter 6(10):58, Oct, 1999
  7. Kaiser Permanente Northern California Regional Drug Formulary, Update 9/99
  8. Physician's Desk Reference (PDR) 56th edition, Medical Economics, 2002
  9. Prescriber's Letter 12(9): 2005 Doxycycline for Osteoarthritis Detail-Document#: 211014 (subscription needed) http://www.prescribersletter.com
  10. Prescriber's Letter 13(7): 2006 New Formulations of Tetracyclines (Solodyn and Oracea) Detail-Document#: 220709 (subscription needed) http://www.prescribersletter.com
  11. Deprecated Reference
  12. Medical Knowledge Self Assessment Program (MKSAP) 17, 19 American College of Physicians, Philadelphia 2015, 2021
  13. Muanda FT, Sheehy O, Berard A Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017 May 1;189:E625-33 PMID: 28461374 http://www.cmaj.ca/content/189/17/E625.full.pdf+html

Component-of

benzoyl peroxide/doxycycline doxycycline/salicylic acid