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Doxycycline: (Dox I Sye' Kleen)
Doxycycline: (Dox I Sye' Kleen)
Pregnancy Category D
Drug classes
Antibiotic
Tetracycline antibiotic
Therapeutic actions
Bacteriostatic: Inhibits protein synthesis of susceptible bacteria, causing cell death.
Indications
Infections caused by rickettsiae; M. pneumoniae; agents of psittacosis, ornithosis,
lymphogranuloma venereum and granuloma inguinale; B. recurrentis; H.
ducreyi; P. pestis; P. tularensis; B. bacilliformis; Bacteroides; V. comma; V.
fetus; Brucella; E. coli; E. aerogenes; Shigella; A. calcoaceticus; H. influenzae;
Klebsiella; D. pneumoniae; S. aureus
When penicillin is contraindicated, infections caused by N. gonorrhoeae, T.
pallidum, T. pertenue, L. monocytogenes, Clostridium, B. anthracis, Chlamydia
psittaci, C. trachomatis
Oral tetracyclines used for acne, uncomplicated adult urethral, endocervical, or
rectal infections caused by C. trachomatis
Acute intestinal amebiasis
Reduction of incidence and progression of disease following exposure to anthrax
Malaria prophylaxis for malaria due to Plasmodium falciparum for short-term use
in travelers
Treatment of periodontal disease as an adjunct to scaling and root planing
Unlabeled use: Prevention of "traveler's diarrhea" commonly caused by
enterotoxigenic E. coli
Available forms
Tablets—50, 75, 100 mg; capsules—50, 100 mg; coated pellets, capsules—75, 100 mg;
powder for oral suspension—25 mg; syrup—50 mg; powder for injection—100, 200 mg
Dosages
ADULTS
General guidelines
200 mg IV in one or two infusions (each over 1–4 hr) on the first treatment day, followed
by 100–200 mg/day IV, depending on the severity of the infection, or 200 mg PO on day
1, followed by 100 mg/day PO.
Primary or secondary syphilis: 300 mg/day IV for 10 days; or 100 mg q 12 hr PO
on the first day, followed by 100 mg/day as one dose or 50 mg q 12 hr PO.
Acute gonococcal infection: 200 mg PO, then 100 mg at bedtime, followed by
100 mg bid for 3 days; or 300 mg PO followed by 300 mg in 1 hr.
Primary and secondary syphilis: 300 mg/day PO in divided doses for at least 10
days.
Traveler's diarrhea: 100 mg/day PO as prophylaxis.
Malaria prophylaxis: 100 mg PO daily.
Anthrax prophylaxis: 100 mg PO bid for 60 days.
CDC recommendations for STDs: 100 mg bid PO for 7–10 days.
Periodontal disease: 20 mg PO bid, following scaling and root planing.
PEDIATRIC PATIENTS
> 8 yr and < 100 lb: 4.4 mg/kg, IV in one or two infusions, followed by 2.2–
4.4 mg/kg/day IV in one or two infusions; or 4.4 mg/kg, PO in two divided doses the first
day of treatment, followed by 2.2–4.4 mg/kg/day on subsequent days.
> 8 yr and > 100 lb: Use adult dosage.
Malaria prophylaxis: 2 mg/kg/day PO, up to 100 mg/day.
Anthrax prophylaxis: 2.2 mg/kg PO bid for 60 days.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE
IV doses of doxycycline are not as toxic as other tetracyclines in these patients.
Pharmacokinetics
Route Onset Peak
Oral Varies 1.5–4 hr
IV Rapid End of infusion
IV facts
Preparation: Prepare solution of 10 mg/mL, reconstitute with 10 mL (100-mg vial):
20 mL (200 mg vial) of sterile water for injection; dilute further with 100–1,000 mL
(100-mg vial) or 200–2,000 mL (200-mg vial) of sodium chloride injection, 5% dextrose
injection, Ringer's injection, 10% invert sugar in water, lactated Ringer's injection, 5%
dextrose in lactated Ringer's, Normosol-M in D5W, Normosol-R in D5W, or Plasma-Lyte
56 or 148 in 5% Dextrose. If mixed in lactated Ringer's or 5% dextrose in lactated
Ringer's, infusion must be completed within 6 hr after reconstitution; otherwise, may be
stored up to 72 hr if refrigerated and protected from light, but infusion should then be
completed within 12 hr; discard solution after that time.
Infusion: Infuse slowly over 1–4 hr.
Adverse effects
Dental: Discoloring and inadequate calcification of primary teeth of fetus if used
by pregnant women, discoloring and inadequate calcification of permanent teeth
if used during period of dental development
Dermatologic: Phototoxic reactions, rash, exfoliative dermatitis (more frequent
and more severe with this tetracycline than with any others)
GI: Fatty liver, liver failure, anorexia, nausea, vomiting, diarrhea, glossitis,
dysphagia, enterocolitis, esophageal ulcer
Hematologic: Hemolytic anemia, thrombocytopenia, neutropenia, eosinophilia,
leukocytosis, leukopenia
Local: Local irritation at injection site
Other: Superinfections, nephrogenic diabetes insipidus syndrome
Interactions
Drug-drug
Decreased absorption with antacids, iron, alkali
Decreased therapeutic effects with barbiturates, carbamazepine, phenytoins
Increased digoxin toxicity with doxycycline
Increased nephrotoxicity with methoxyflurane
Decreased activity of penicillins
Drug-food
Decreased effectiveness of doxycycline if taken with food, dairy products
Drug-lab test
Interference with culture studies for several days following therapy
Nursing considerations
Assessment
History: Allergy to tetracyclines, renal or hepatic dysfunction, pregnancy,
lactation
Physical: Skin status, R and sounds, GI function and liver evaluation, urinary
output and concentration, urinalysis and BUN, liver and renal function tests;
culture infected area before beginning therapy
Interventions
Administer the oral medication without regard to food or meals; if GI upset
occurs, give with meals; patients being treated for periodontal disease should
receive tablet at least 1 hr before morning and evening meals.
Protect patient from light and sun exposure.
Teaching points
Take drug throughout the day for best results; if GI upset occurs, take drug with
food. If being treated for periodontal disease, take at least 1 hr before morning and
evening meals.
Avoid pregnancy while using this drug; using barrier contraceptives is advised.
These side effects may occur: Sensitivity to sunlight (wear protective clothing,
use sunscreen), diarrhea.
Report rash, itching, difficulty breathing, dark urine or light-colored stools, pain
at injection site.
Adverse effects in Italic are most common; those in Bold are life-threatening.