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)

• Traveler’s 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

• Traveler’s 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