Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

For use in patients with reported penicillin allergies, see Appendix J: UWHC Guidelines For the Use of Beta-LactamAntibiotics in Patients with Reported Allergies to Penicillin.DOXYCYCLINEUsual DoseAdult: Load 200 mg, then 100 mg Q12H IV/PO; Maintenance 100-200 mg daily or 100 mg BID IV/PO (PO UWHC cost/day$0.14-0.28; IV UWHC cost/day $14.79-29.58).Pediatrics:** 2-4 mg/kg/day PO Q12H on day 1, then half dose Q24H (not for children < 8 years).Indications1. Pneumonia caused by Mycoplasma pneumoniae, Chlamydia or Legionella -- alternative treatment to macrolides.2. Uncomplicated Chlamydia trachomatis and non-gonococcal urethritis infections in adults.3. Brucellosis and bartonellosis in combination with rifampin.4. Rickettsial infections (e.g. Rocky Mountain Spotted Fever, Q fever).5. Acute exacerbations of chronic bronchitis.6. Lyme disease in adults and children 8 years or older.7. Malaria chemoprophylaxis in areas where chloroquine-resistant Plasmodium falciparum is prevalent (100 mg daily PO,start 1-2 days before travel and continue for 4 weeks after leaving malarious area). Alternative to mefloquine.8. Treatment of chloroquine-resistant Plasmodium falciparum in combination with quinine.9. Traveler’s diarrhea – third-line agent (after quinolones and trimethoprim/sulfamethoxazole) for treatment or prophylaxisin persons traveling to high risk areas.10. Plague and tularemia - alternative to streptomycin for treatment. May be used for prophylaxis in selected patients.11. Inflammatory acne - alternative to oral erythromycin or tetracycline.12. Ehrlichiosis.13. Primary or secondary syphilis in patients with an anaphylactoid-type reaction to penicillin.14. CAP treatment: alternative for outpatient treatment and for non-ICU inpatient15. Susceptible community-acquired MRSA infections.16. Susceptible VRE in the urine.CommentsDoxycycline can cause discoloration of permanent teeth and should not be used during the last half of pregnancy nor inchildren < 8 years old. Doxycycline may cause photosensitivity reactions. Patients should be counseled to avoid directsunlight and to apply sunscreens. The IV load may be given as one or two infusions. Close follow-up is mandatory inpatients with syphilis who receive tetracyclines due to reduced cure rates compared to penicillin. Tetracyclines appear tobe superior to penicillin for treatment of early Lyme disease.Drug InteractionsDoxycycline is contraindicated with acitretin because the combination may increase ICP.Concurrent administration with isotretinoin may cause pseudotumor cerebri.Divalent cations such as calcium, iron, aluminum or zinc will chelate doxycycline, preventing its absorption.Medications containing these ions should be given 2 hours before or 6 hours after doxycycline.Concurrent administration with methotrexate increases methotrexate toxicity due to displacement from plasma proteins.Concurrent administration with many neuromuscular blockers increases the activity of the NMB.Concurrent administration with warfarin increases the risk of bleeding.Concurrent administration with porfimer increases intracellular damage due to increased photosensitivity.Concurrent administration with oral contraceptives may cause a failure of the contraceptive.Rifampin decreases the efficacy of doxycycline via increased clearance.Phenytoin and fosphenytoin decrease the efficacy of doxycycline due to induction of metabolism.Phenobarbital decreases the efficacy of doxycycline due to the induction of metabolism.Concurrent administration with chronic carbamazepine administration reduces the efficacy of doxycycline due toincreased metabolism.