Doxycycline

(DOX-ee-SIGH-kleen)

  Action:
Inhibits bacterial protein synthesis.

  Indications:
Treatment of infections caused by susceptible strains of gram-positive and gram-negative bacteria, Rickettsia, Mycoplasma pneumoniae; treatment of trachoma and susceptible infections when penicillins are contraindicated; treatment of acute intestinal amebiasis, uncomplicated gonorrhea in adults; prophylaxis of malaria caused by Plasmodium falciparum.

Periodontitis: Adjunct treatment to scaling and root planing to promote attachment level gain and reduce pocket depth. Unlabeled use(s): Prevention of "traveler's diarrhea."

  Contraindications:
Hypersensitivity to tetracyclines; nursing mothers, infancy, and childhood (
Periostat).

  Route/Dosage:

Infection

Adults and children > 8 yr and > 45 kg:
PO/IV 200 mg day 1, then 100 to 200 mg qd in single or divided doses.

Children > 8 yr and < 45 kg:
PO/IV 4.4 mg/kg day 1, then 2.2 mg/kg in single or 2 divided doses.

Children > 8 yr: 2 mg/kg/day; do not exceed 100 mg/day.

Acute Gonococcal Infection

Adults and Children < 8 yr (and 45 kg):
PO 200 mg immediately, then 100 mg at bedtime day 1, then 200 mg qd for 3 days.
PO 300 mg immediately, followed by 300 mg in 1 hr.

Primary/Secondary Syphilis

Adults (Nonpregnant Penicillin-Allergic):
PO/IV 100 mg bid for 2 wk.

Chlamydia

Adults and Children 8 yr:
PO 100 mg bid for 7 days.

Malaria Prophylaxis

Adults:
PO 100 mg qd, beginning 1 to 2 days before travel and continuing for 4 wk after leaving area.

Periodontitis

Adults:
PO 20 mg bid as an adjunct following scaling and root planing for 9 mo. Administer tablets 1 hr before or 2 hr after meals; administer capsules 1 hr before the morning and evening meals.

  Interactions:

Antacids containing aluminum, zinc, calcium, magnesium, bismuth salts, divalent/trivalent cations: May decrease oral absorption of doxycycline.

Barbiturates, carbamazepine, hydantoins: May increase metabolism of and decrease effect of doxycycline.

Digoxin: May increase digoxin serum levels.

Iron salts: May decrease absorption of doxycycline.

Methoxyflurane: Increased potential for nephrotoxicity exists; do not use together.

Penicillins: May interfere with bactericidal action of penicillins.

  Lab Test Interferences:
False elevations of urinary catecholamine levels may occur because of interference with fluorescence test.

  Adverse Reactions:

CNS:

Pseudotumor cerebri, manifested by headache and blurred vision.

DERM:

Rash; photosensitivity.

GI:

Diarrhea; nausea; vomiting; abdominal pain or discomfort; anorexia; bulky, loose stools; sore throat; glossitis.

HEMA:

Hemolytic anemia; thrombocytopenia; neutropenia.

OTHER:

Hypersensitivity reactions (eg, urticaria, anaphylaxis, pericarditis).

  Precautions:

Pregnancy: Category D.

Lactation: Excreted in breast milk.

Children: Not recommended in children < 8 yrs; abnormal bone formation and tooth discoloration may result.

Anticoagulants: May need to decrease dosage of anticoagulant.

Hepatic effects: Doses > 2 g/day have been associated with liver failure; monitor function and avoid other hepatotoxic drugs.

Outdated product: Do not use; degradation products of drug are highly nephrotoxic.

Photosensitivity: May occur; avoid exposure to sunlight or ultraviolet light.

Prolonged use: May result in thrombophlebitis; use oral form whenever reasonable.

Renal impairment: Dosage reduction is required.

Superinfection: Prolonged use may result in bacterial or fungal overgrowth.

  Administration/Storage:

Oral

• Do not administer oral form with antacids.

Parenteral

• Do not inject via IM or SC route.
• Reconstitute vial contents with 10 mL of Sterile Water for Injection. Dilute further with D5W or normal saline to make concentration of 0.1 to 1 mg/mL.
• For solutions diluted with Lactated Ringer's Injection or 5% Dextrose in Lactated Ringer's, use within 6 hr of reconstitution. Discard any remaining solution.
• For solutions diluted with other preparations, store up to 72 hr before infusion. Complete infusion within 12 hr to ensure stability. Keep solution refrigerated and protect from light.

  Assessment/Interventions:

• Obtain patient history, including drug history and any known allergies.
• Review baseline WBC and BUN and monitor throughout therapy.
• Withhold drug and notify health care provider if GI disturbances develop.
• Monitor body temperature.
• Inform health care provider of signs/symptoms of superinfection.

  Patient/Family Education:

• Instruct patient not to take medication with antacids.
• Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
• Explain rationale and techniques for oral hygiene.
• Tell patient to increase fluid intake and to take medication after meals.
• Inform patient of possible skin rash (eg, maculopapular, erythematous).
• Instruct patient to report any visual changes and any additional infections to health care provider.
• Explain missed medication procedure: < 2 hr, take medication; > 2 hr, wait until next scheduled dose. Do not double up on medication.

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