Antimicrobials
Doxycycline

Doxycycline

C difficile risk
Low
Oral Bioavailability
Excellent
Cost
PO: $-$$

Dosing

TreatmentTick Bite Prophylaxis2 mg/kg/dose PO q12h for 14 days Dose limit: 100 mg/dose4.4 mg/kg/dose PO once as a single dose, initiate within 72 hours of tick removal Dose limit: 200mg/dose- Prophylaxis with a single dose of doxycycline for tick bites can be considered if the tick was engorged, tick was attached >36 hours, and prophylaxis is given within 72 hours of tic removal

  • If tick attachment <36 hours with no Lyme Disease manifestations, no prophylaxis is indicated

InpatientOutpatient- Treatment ≥8 years: 100 mg/dose PO bid PLUS Cefoxitin 25 mg/kg/dose IV q6h

Dose limit: 2 g/dose)- Ceftriaxone 250 mg IM as a single dose PLUS doxycycline 100 mg PO bid x 14 days

OR

  • Cefoxitin 2 g IM plus probenecid 1 g PO as a single dose, concurrently PLUS doxycycline 100 mg PO bid x 14 days

2 mg/kg/dose PO q12h for 5-10 days depending on severity Dose limit: 100 mg/dose

TreatmentProphylaxis2 mg/kg/dose PO bid for 7 days Dose limit: 200 mg/day2 mg/kg/dose PO once daily Dose limit: 100 mg/day

No renal adjustment required

General Information

  • Cutaneous Abscesses, Furuncles, Carbuncles, and Boils (with or without cellulitis):

    • If there are risk factors for MRSA* or failed 1st-line outpatient treatment despite adequate adherence
    • PO: Doxycycline (if ≥ 8 yrs old)
  • Use Clindamycin or Doxycycline if Group A strep is strongly suspected despite the failure of 1st-line treatment

  • Tick Bites:

    • Oral: Doxycycline (≥8 yrs)

ODB Funded (tablet)

  • GI upset and erosive esophagitis

  • Photosensitivity rash

  • Teeth staining

With long-term use, monitor BUN, hematologic, and hepatic function tests; observe for changes in bowel frequency

  • May be given with food

  • Food decreases GI side effects; take with a glass of water to avoid esophageal ulceration; avoid concomitant use of antacids or drugs containing aluminum, calcium, magnesium or iron

  • Not recommended for children less than 8 years old, with exception for circumstances when benefits outweigh risks

  • Intravenous doxycycline is not marketed in Canada; may be available through the Special Access Program (SAP)