doxycycline

Adult Dosing .

Dosage forms:  CAP: 50 mg, 75 mg, 100 mg, 150 mg; DR CAP (75% IR/25% DR): 40 mg; TAB: 20 mg, 50 mg, 75 mg, 100 mg, 150 mg; DR TAB: 50 mg, 75 mg, 100 mg, 150 mg, 200 mg; SUSP: 25 mg per 5 mL; INJ: various

Special Note

[formulation clarification]

Info: 40 mg DR cap not bioequivalent or interchangeable w/ other doxycycline products; do not substitute on a mg to mg basis

infections, mild-moderate bacterial

[100 mg PO/IV qd]

Start: 100 mg PO/IV bid x1 day; Info: duration varies by indication

infections, severe bacterial

[100 mg PO/IV bid]

Info: duration varies by indication

severe acne vulgaris, adjunct tx

[50-100 mg PO qd]

Start: 50-100 mg PO bid x2-3mo

rosacea inflammatory lesions

[40 mg DR PO qam]

Info: give 1h before or 2h after meal

pneumonia, community-acquired

[100 mg PO/IV q12h for at least 5 days]

Info: refer to IDSA guidelines

periodontitis

[20 mg PO q12h]

Info: for adjunct tx following scaling and root planing; duration may continue up to 9mo

sinusitis, acute bacterial

[200 mg/day PO divided q12-24h x5-7 days]

infections, chlamydial

[treatment]

Dose: 100 mg PO q12h x7 days; Info: 1st-line agent

[presumptive tx (off-label)]

Dose: 100 mg PO q12h x7 days; Info: for sexual assault victims; give w/ ceftriaxone and metronidazole in female pts; give w/ ceftriaxone in male pts

[post-exposure prophylaxis (off-label)]

Dose: 200 mg PO x1; Start: w/in 72h of oral, vaginal, or anal sex; Max: 200 mg/24h; Info: for men who have sex with men and transgender women w/ hx of at least 1 bacterial sexually transmitted infection during the past 12mo; may repeat dose

syphilis

[primary, secondary, or latent <1y]

Dose: 100 mg PO q12h x14 days; Info: for pts w/ hypersens. to PCN; not 1st-line agent

[latent >1y or unknown duration]

Dose: 100 mg PO q12h x28 days; Info: for pts w/ hypersens. to PCN; not 1st-line agent

[post-exposure prophylaxis (off-label)]

Dose: 200 mg PO x1; Start: w/in 72h of oral, vaginal, or anal sex; Max: 200 mg/24h; Info: for men who have sex with men and transgender women w/ hx of at least 1 bacterial sexually transmitted infection during the past 12mo; may repeat dose

lymphogranuloma venereum

[100 mg PO q12h x21 days]

Info: may give for 7 days if asymptomatic dz; 1st-line agent

urethritis, non-gonococcal

[100 mg PO q12h x7 days]

Info: 1st-line agent

epididymitis

[100 mg PO q12h x10 days]

Info: give w/ ceftriaxone

proctitis

[100 mg PO q12h x7 days]

Info: give w/ ceftriaxone; extend duration to 21 days if positive rectal chlamydia test w/ bloody discharge, perianal or mucosal ulcers, or tenesmus

anthrax

[systemic]

Dose: 100 mg IV q12h for at least 2wk; Start: 200 mg IV x1; Info: not recommended for CNS anthrax; may use in pregnant women; not 1st-line agent; part of multi-drug regimen; switch to PO abx for post-exposure prophylaxis if inhalational exposure

[cutaneous]

Dose: 100 mg PO q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; use extended duration for post-exposure prophylaxis if bioterrorism suspected; may use in pregnant women

[post-exposure prophylaxis]

Dose: 100 mg PO q12h x60 days; Info: 1st-line agent; give in combo w/ anthrax vaccine; may use in pregnant women; may give x42 days, or x14 days after last vaccine dose, in immunocompetent pts 18-65 yo if anthrax vaccine regimen completed

malaria prophylaxis

[100 mg PO qd]

Start: 1-2 days before exposure; Info: D/C 4wk after exposure; see CDC Pre-Travel Malaria Prophylaxis recommendations in Guidelines > Specialties > Infectious Diseases

tularemia

[100 mg PO/IV q12h x14-21 days]

Rocky Mountain spotted fever

[100 mg PO/IV q12h x5-14 days]

cholera

[300 mg PO/IV x1]

brucellosis

[100 mg PO q12h x6wk]

Info: part of multi-drug regimen

granuloma inguinale

[100 mg PO q12h for at least 3wk]

Info: may extend tx if not healed after 3wk; not 1st-line agent

PID (off-label)

[mild-moderate infection]

Dose: 100 mg PO q12h x14 days; Info: give w/ ceftriaxone and metronidazole, cefotaxime and metronidazole, or cefoxitin plus probenecid and metronidazole; 1st-line agent

[severe infection]

Dose: 100 mg PO/IV q12h x14 days; Info: give w/ ceftriaxone plus metronidazole, cefotetan, cefoxitin, ampicillin/sulbactam, or cefotaxime plus metronidazole; 1st-line agent; switch to PO regimen ASAP to complete course

gonococcal infections, post-exposure prophylaxis (off-label)

[200 mg PO x1 dose]

Start: w/in 72h of oral, vaginal, or anal sex; Max: 200 mg/24h; Info: for men who have sex with men and transgender women w/ hx of at least 1 bacterial sexually transmitted infection during the past 12mo; may repeat dose

Lyme dz (off-label)

[100 mg PO q12h x14-21 days]

Alt: 200 mg q24h x14-21 days; Info: may give for 10-14 days if early, localized dz; extend duration to 28 days if Lyme arthritis; 1st-line agent; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

Lyme dz prophylaxis, post-exposure (off-label)

[200 mg PO x1 dose]

Start: w/in 72h of tick removal after high-risk bite; Info: search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

cervicitis, presumptive (off-label)

[100 mg PO q12h x7 days]

Info: 1st-line agent

Mycoplasma genitalium infection (off-label)

[macrolide-susceptible]

Dose: 100 mg PO q12h x7 days; Info: follow w/ azithromycin 1 g PO x1, then 500 mg PO qd x3 days

[macrolide-resistant or resistance unknown]

Dose: 100 mg PO q12h x7 days; Info: follow w/ moxifloxacin 400 mg PO qd x7 days

endocarditis prophylaxis, dental (off-label)

[100 mg PO x1]

Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Adult table

malaria tx, uncomplicated (off-label)

[100 mg PO q12h x7 days]

Info: give w/ quinine sulfate; follow up tx w/ primaquine to avoid relapse in acute P. vivax or P. ovale infection; refer to CDC guidelines

non-cholera vibrio infection, gastroenteritis (off-label)

[100 mg PO q12h x3 days]

Info: for diarrhea persisting >5 days

non-cholera vibrio infection, invasive dz (off-label)

[100 mg IV q12h]

Info: part of multi-drug regimen

anaplasmosis (off-label)

[100 mg PO/IV q12h x10-14 days]

ehrlichiosis (off-label)

[100 mg PO/IV q12h x5-14 days]

onchocerciasis (off-label)

[200 mg PO qd x6wk]

Start: 1wk after ivermectin tx; Info: may decr. to 100 mg PO qd if not tolerated; not 1st-line agent

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms:  CAP: 50 mg, 75 mg, 100 mg, 150 mg; TAB: 20 mg, 50 mg, 75 mg, 100 mg, 150 mg; DR TAB: 50 mg, 75 mg, 100 mg, 150 mg, 200 mg; SUSP: 25 mg per 5 mL; INJ: various

infections, mild-moderate bacterial

[>8 yo]

Dose: 2.2 mg/kg/dose PO/IV qd; Start: 2.2 mg/kg/dose PO/IV bid x1 day; Max: 100 mg/dose; Info: duration varies by indication

infections, severe bacterial

[>8 yo]

Dose: 2.2 mg/kg/dose PO/IV bid; Max: 100 mg/dose; Info: duration varies by indication

severe acne vulgaris, adjunct tx

[>8 yo]

Dose: 50-100 mg PO qd; Start: 50-100 mg PO bid x2-3mo; Max: 100 mg/dose

community-acquired pneumonia, atypical

[>8 yo]

Dose: 2.2-4.4 mg/kg/day PO divided q12h x7-10 days

infections, chlamydial

[treatment, 8 yo and older]

Dose: 100 mg PO q12h x7 days; Info: 1st-line agent

[presumptive tx, 8 yo and older (off-label)]

Dose: 100 mg PO q12h x7 days; Info: for sexual assault victims; give w/ ceftriaxone and metronidazole in female pts; give w/ ceftriaxone in male pts

syphilis

[primary, secondary, or latent <1y, adolescents]

Dose: 100 mg PO q12h x14 days; Info: for pts w/ hypersens. to PCN; not 1st-line agent

[latent >1y or unknown duration, adolescents]

Dose: 100 mg PO q12h x28 days; Info: for pts w/ hypersens. to PCN; not 1st-line agent

lymphogranuloma venereum

[preadolescents >45 kg and adolescents]

Dose: 100 mg PO q12h x21 days; Info: may give for 7 days if asymptomatic dz; 1st-line agent

urethritis, non-gonococcal

[preadolescents >45 kg and adolescents]

Dose: 100 mg PO q12h x7 days; Info: 1st-line agent

epididymitis

[preadolescents >45 kg and adolescents]

Dose: 100 mg PO q12h x10 days; Info: give w/ ceftriaxone

proctitis

[preadolescents >45 kg and adolescents]

Dose: 100 mg PO q12h x7 days; Info: give w/ ceftriaxone; extend duration to 21 days if positive rectal chlamydia test w/ bloody discharge, perianal or mucosal ulcers, or tenesmus

anthrax

[systemic]

Dose: 2.2 mg/kg/dose IV q12h for at least 2wk; Max: 100 mg/dose; Info: not recommended for CNS anthrax; not 1st-line agent; part of multi-drug regimen; switch to PO abx x60 days total if inhalational exposure

[cutaneous]

Dose: 2.2 mg/kg/dose PO q12h x7-10 days; Max: 100 mg/dose; Info: for non-systemic infection; give abx x60 days total if bioterrorism suspected

[post-exposure prophylaxis]

Dose: 2.2 mg/kg/dose PO q12h x60 days; Max: 100 mg/dose; Info: 1st-line agent

malaria prophylaxis

[>8 yo]

Dose: 2.2 mg/kg/dose PO qd; Start: 1-2 days before exposure; Max: 100 mg/day; Info: D/C 4wk after exposure; see CDC Pre-Travel Malaria Prophylaxis recommendations in Guidelines > Specialties > Infectious Diseases

Rocky Mountain spotted fever

[2.2 mg/kg/dose PO/IV q12h x5-14 days]

Max: 100 mg/dose

cholera

[>8 yo]

Dose: 4.4-6.6 mg/kg/dose PO/IV x1; Max: 300 mg/dose

brucellosis

[>8 yo]

Dose: 100 mg PO q12h x6wk; Info: part of multi-drug regimen

granuloma inguinale

[adolescents]

Dose: 100 mg PO q12h for at least 3wk; Info: may extend tx if not healed after 3wk; not 1st-line agent

PID (off-label)

[mild-moderate infection, preadolescents >45 kg and adolescents]

Dose: 100 mg PO q12h x14 days; Info: give w/ ceftriaxone and metronidazole, cefotaxime and metronidazole, or cefoxitin plus probenecid and metronidazole; 1st-line agent

[severe infection, preadolescents >45 kg and adolescents]

Dose: 100 mg PO/IV q12h x14 days; Info: give w/ ceftriaxone plus metronidazole, cefotetan, cefoxitin, ampicillin/sulbactam, or cefotaxime plus metronidazole; 1st-line agent; switch to PO regimen ASAP to complete course

Lyme dz (off-label)

[2.2 mg/kg/dose PO q12h x14-21 days]

Max: 100 mg/dose; Info: may give for 10-14 days if early, localized dz; extend duration to 28 days if Lyme arthritis; 1st-line agent; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

Lyme dz prophylaxis, post-exposure (off-label)

[4.4 mg/kg/dose PO x1 dose]

Start: w/in 72h of tick removal after high-risk bite; Max: 200 mg/dose; Info: search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

cervicitis, presumptive (off-label)

[preadolescents >45 kg and adolescents]

Dose: 100 mg PO q12h x7 days; Info: 1st-line agent

Mycoplasma genitalium infection (off-label)

[macrolide-susceptible, adolescents]

Dose: 100 mg PO q12h x7 days; Info: follow w/ azithromycin 1 g PO x1, then 500 mg PO qd x3 days

[macrolide-resistant or resistance unknown, adolescents]

Dose: 100 mg PO q12h x7 days; Info: follow w/ moxifloxacin 400 mg PO qd x7 days

endocarditis prophylaxis, dental (off-label)

[<45 kg]

Dose: 2.2 mg/kg/dose PO x1; Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Pediatric table

[>45 kg]

Dose: 100 mg PO x1; Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Pediatric table

malaria tx, uncomplicated (off-label)

[2.2 mg/kg/dose PO q12h x7 days]

Max: 100 mg/dose; Info: give w/ quinine sulfate; follow up tx w/ primaquine to avoid relapse in acute P. vivax or P. ovale infection; refer to CDC guidelines

non-cholera vibrio infection, gastroenteritis (off-label)

[>8 yo, <45 kg]

Dose: 2.2 mg/kg/dose PO q12h x3 days; Max: 200 mg/day; Info: for diarrhea persisting >5 days

[>8 yo, >45 kg]

Dose: 100 mg PO q12h x3 days; Info: for diarrhea persisting >5 days

non-cholera vibrio infection, invasive dz (off-label)

[>8 yo, <45 kg]

Dose: 2.2 mg/kg/dose PO/IV q12h; Max: 200 mg/day; Info: part of multi-drug regimen

[>8 yo, >45 kg]

Dose: 100 mg PO/IV q12h; Info: part of multi-drug regimen

anaplasmosis (off-label)

[2.2 mg/kg/dose PO/IV q12h x10-14 days]

Max: 100 mg/dose

ehrlichiosis (off-label)

[2.2 mg/kg/dose PO/IV q12h x5-14 days]

Max: 100 mg/dose

onchocerciasis (off-label)

[200 mg PO qd x6wk]

Start: 1wk after ivermectin tx; Info: may decr. to 100 mg PO qd if not tolerated; not 1st-line agent

renal dosing

[no adjustment]

renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]