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تعداد ایتم قابل مشاهده باقیمانده : 4 مورد

Doxycycline: Drug information

Doxycycline: Drug information
(For additional information see "Doxycycline: Patient drug information" and see "Doxycycline: Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp (show table)
Brand Names: US
  • Acticlate;
  • Avidoxy;
  • Doryx;
  • Doryx MPC;
  • Doxy 100;
  • Mondoxyne NL;
  • Monodox [DSC];
  • Morgidox;
  • Okebo [DSC];
  • Oracea;
  • Soloxide [DSC];
  • TargaDOX;
  • Vibramycin
Brand Names: Canada
  • APO-Doxy;
  • Apprilon;
  • Doxycin;
  • Doxytab;
  • Periostat;
  • PMS-Doxycycline [DSC];
  • TEVA-Doxycycline
Pharmacologic Category
  • Antibiotic, Tetracycline Derivative
Dosing: Adult

Note: Doxycycline is available as hyclate, monohydrate, and calcium salts. All doses are expressed as doxycycline base.

Usual dosage range:

Oral: IR and most ER formulations: 100 to 200 mg/day in 1 to 2 divided doses. Note: 120 mg of modified polymer coated tablet (Doryx MPC) is equivalent to 100 mg conventional delayed-release tablet.

IV: 100 mg every 12 hours. Note: IV form may cause phlebitis.

Acne vulgaris (moderate to severe, inflammatory) (off-label dose): Oral: Note: Use as an adjunct to topical acne therapy (AAD [Zaenglein 2016]).

Immediate release: 50 to 100 mg twice daily or 100 mg once daily (AAD [Zaenglein 2016]; Graber 2020).

Extended release: 100 mg twice daily on day 1, then 100 mg once daily (AAD [Zaenglein 2016]; Graber 2020).

Subantimicrobial dosing: 20 mg twice daily (immediate release) or 40 mg once daily (delayed release) (Moore 2015; Skidmore 2003).

Duration: Use the shortest possible duration to minimize risk of adverse effects and development of bacterial resistance; re-evaluate at 3 to 4 months (AAD [Zaenglein 2016]).

Actinomycosis (alternative agent): Oral, IV: 100 mg every 12 hours (Brook 2020; Cone 2003; Olson 2013). Duration of therapy is 2 to 6 months for mild infection and 6 to 12 months (including 4 to 6 weeks of parenteral therapy) for severe or extensive infection (Brook 2020).

Anaplasmosis and ehrlichiosis (off-label use): Oral, IV: 100 mg twice daily for 10 days (IDSA [Wormser 2006]) or at least 3 days after resolution of fever (CDC [Biggs 2016]).

Anthrax: Note: Consult public health officials for event-specific recommendations.

Inhalational exposure (postexposure prophylaxis [PEP]): Oral: 100 mg every 12 hours for 42 to 60 days (CDC [Hendricks 2014]).

Note: Anthrax vaccine should also be administered to exposed individuals (CDC [Bower 2019]; CDC [Hendricks 2014]). Duration of therapy: If the PEP anthrax vaccine series is administered on schedule (for all regimens), antibiotics may be discontinued in immunocompetent adults aged 18 to 65 years at 42 days after initiation of vaccine or 2 weeks after the last dose of the vaccine (whichever comes last and not to exceed 60 days); if the vaccination series cannot be completed, antibiotics should continue for 60 days (CDC [Bower 2019]). In addition, adults with immunocompromising conditions or receiving immunosuppressive therapy, patients >65 years of age, and patients who are pregnant or breastfeeding should receive antibiotics for 60 days (CDC [Bower 2019]).

Cutaneous (without systemic involvement), treatment: Oral: 100 mg every 12 hours for 7 to 10 days after naturally acquired infection; treat for 60 days for bioterrorism-related cases (CDC [Hendricks 2014]). Note: Patients with cutaneous lesions of the head or neck or extensive edema should be treated for systemic involvement.

Systemic (meningitis excluded; alternative agent), treatment: IV: Initial: 200 mg as a single dose, then 100 mg every 12 hours, in combination with a bactericidal agent; treat for 2 weeks or until clinically stable, whichever is longer. Note: Antitoxin should also be administered for systemic anthrax. Following a course of IV combination therapy, patients exposed to aerosolized spores require oral doxycycline monotherapy to complete an antimicrobial course of 60 days (CDC [Hendricks 2014]).

Bartonella spp. infection:

HIV-infected: Note: Duration of therapy is at least 3 months; continuation of therapy depends on relapse occurrence and clinical condition (HHS [OI adult 2020]).

Bacillary angiomatosis, peliosis hepatis, bacteremia, and osteomyelitis: Oral, IV: 100 mg every 12 hours (HHS [OI adult 2020]). Note: Some experts recommend concomitant gentamicin for the first 2 weeks of therapy for patients with Bartonella bloodstream infection (Rolain 2004; Spach 2019a).

CNS infections: Oral, IV: 100 mg every 12 hours; may add rifampin therapy (HHS [OI adult 2020]).

Endocarditis: Oral, IV: 100 mg IV every 12 hours in combination with gentamicin for 2 weeks, then continue with doxycycline 100 mg IV or orally every 12 hours (HHS [OI adult 2020]).

Other severe infections: Oral, IV: 100 mg every 12 hours in combination with rifampin (HHS [OI adult 2020]).

HIV-uninfected:

Bacteremia without endocarditis: Oral: 200 mg once daily or 100 mg twice daily for 4 weeks with gentamicin once daily for first 2 weeks (Foucault 2003; Rolain 2004).

Cat-scratch disease, CNS infection, and neuroretinitis: Oral, IV: 100 mg twice daily in combination with rifampin (Rolain 2004).

Endocarditis: Oral: 100 mg every 12 hours for 6 to 12 weeks with gentamicin for first 2 weeks (Rolain 2004; Spach 2019b).

Bite wound infection, prophylaxis or treatment (animal or human bite) (alternative agent) (off-label use): Oral, IV: 100 mg twice daily. Duration is 3 to 5 days for prophylaxis (IDSA [Stevens 2014]); duration of treatment for established infection is typically 5 to 14 days (Baddour 2021a; Baddour 2019). Note: Some experts use in combination with an appropriate agent for anaerobes (Baddour 2021a; Baddour 2019; IDSA [Stevens 2014]).

Brucellosis:

Treatment:

Endocarditis or neurobrucellosis: Limited data available: IV, Oral: 100 mg twice daily for at least 12 weeks (may be needed for up to 6 months); use as part of an appropriate combination regimen (Bosilkovski 2019; Jia 2017; Zheng 2018).

Uncomplicated (nonfocal): Oral: 100 mg twice daily for 6 weeks as part of an appropriate combination regimen (Ariza 2007; Hasanjani Roushan 2006; Skalsky 2008).

Spondylitis: Oral: 100 mg twice daily for at least 12 weeks as part of an appropriate combination regimen (Bosilkovski 2019; Colmenero 1994).

Postexposure prophylaxis (high-risk laboratory exposure): Oral: 100 mg twice daily with rifampin for 3 weeks (CDC 2012); for exposure to B. abortus RB51 strains, some experts give doxycycline plus trimethoprim-sulfamethoxazole (Bosilkovski 2019).

Cholera (Vibrio cholerae), treatment (adjunctive therapy for severely ill patients): Oral: 300 mg as a single dose. Note: Due to resistance concerns, antimicrobial therapy during an outbreak or epidemic should be guided by isolate susceptibility (CDC 2015; WHO 2010).

Chronic obstructive pulmonary disease, acute exacerbation (off-label use): Oral: 100 mg once or twice daily for 5 to 7 days (Anthonisen 1987; Daniels 2010; GOLD 2021). Note: Some experts reserve for patients with uncomplicated COPD (eg, <65 years of age without major comorbidities, FEV1 >50% predicted, infrequent exacerbations) (Anzueto 2007; Sethi 2008).

Hidradenitis suppurativa (off-label use): Oral: 100 mg once or twice daily (Ingram 2020; Vural 2019).

Lyme disease (Borrelia spp. infection) (off-label use):

Prophylaxis: Oral: 200 mg as a single dose. Note: Prophylaxis is used only in patients who meet all of the following criteria: Ixodes spp. tick attached for ≥36 hours, prophylaxis can be given within 72 hours of tick removal, and local rate of Ixodes spp. tick infection with Borrelia burgdorferi is ≥20% (IDSA/AAN/ACR [Lantos 2021]).

Treatment, erythema migrans : Oral: 100 mg twice daily for 10 days (Dattwyler 1997; IDSA/AAN/ACR [Lantos 2021]; Wormser 2003).

Treatment, acute neurologic disease (isolated facial nerve palsy, meningitis, or radiculoneuropathy): Oral: 100 mg twice daily for 14 to 21 days (IDSA/AAN/ACR [Lantos 2021]).

Treatment, carditis (initial therapy for mild disease [first-degree atrioventricular block with PR interval <300 msec] or step-down therapy after initial parenteral treatment for more severe disease once PR interval <300 msec): Oral: 100 mg twice daily for 14 to 21 days (IDSA/AAN/ACR [Lantos 2021].

Treatment, arthritis without neurologic involvement: Oral: 100 mg twice daily for 28 days (IDSA/AAN/ACR [Lantos 2021]).

Malaria:

Prophylaxis: Oral (immediate release and delayed release): 100 mg daily; initiate 1 to 2 days prior to travel to endemic area; continue daily during travel and for 4 weeks after leaving endemic area.

Treatment (alternative agent) (off-label use): Oral: 100 mg twice daily for 7 days in combination with quinine sulfate (quinine sulfate duration is region specific). Note: If used for P. vivax or P. ovale, use this regimen in combination with primaquine. If used for severe malaria (after completion of IV therapy), use full 7-day schedule of doxycycline (CDC 2020).

Otitis media, acute (alternative agent if unable to tolerate penicillins and cephalosporins) (off-label use): Oral: 100 mg every 12 hours; duration of therapy is 5 to 7 days (mild to moderate infection) or 10 days (severe infection) (Limb 2019).

Periodontitis, chronic: Subantimicrobial dosing: Oral: 20 mg twice daily (immediate release) for 3 to 9 months as an adjunct to periodontal debridement (Smiley 2015).

Plague (Yersinia pestis) (alternative agent): Oral, IV: 200 mg initially then 100 mg twice daily or 200 mg once daily for 10 to 14 days and at least until 2 days after patient has defervesced (CDC 2015; IDSA [Stevens 2014]; Inglesby 2000; Stout 2021).

Pleurodesis, chemical (sclerosing agent for pleural effusion) (off-label use): Intrapleural: 500 mg as a single dose in 30 to 100 mL NS (Porcel 2006; Robinson 1993); may require a repeat dose (Kvale 2007); some experts combine with or administer following instillation of a local anesthetic (eg, lidocaine, 10 mL [100 mg] of 1% solution [Robinson 1993] or mepivacaine 20 mL [400 mg] of 2% solution [Porcel 2006]).

Pneumonia, community-acquired, empiric therapy:

Outpatients with no risk factors for antibiotic resistant pathogens: Oral: 100 mg twice daily; must be used as part of an appropriate combination regimen in outpatients with comorbidities (ATS/IDSA [Metlay 2019]). Some experts prefer to use as part of an appropriate combination regimen in all outpatients, regardless of comorbidities (File 2019).

Inpatients (alternative agent): Oral, IV: 100 mg twice daily as part of an appropriate combination regimen (ATS/IDSA [Metlay 2019]).

Duration: Minimum of 5 days; patients should be clinically stable with normal vital signs before discontinuing therapy (ATS/IDSA [Metlay 2019]).

Prosthetic joint infection (off-label use):

Treatment: Oral continuation therapy for S. aureus (following pathogen-specific IV therapy in patients undergoing 1-stage exchange or debridement with retention of prosthesis) (alternative agent): Oral: 100 mg twice daily in combination with rifampin; duration is a minimum of 3 months, depending on patient-specific factors (Berbari 2019; IDSA [Osmon 2013]).

Chronic suppression for staphylococci (methicillin resistant) and Cutibacterium acnes (alternative agent for C. acnes): Oral: 100 mg twice daily (IDSA [Osmon 2013]).

Q fever (C. burnetii) :

Acute symptomatic: Note: Treatment is most effective if given within the first 3 days of symptoms (CDC [Anderson 2013]).

Oral: 100 mg every 12 hours for 14 days (CDC [Anderson 2013]). Note: Some experts use in combination with hydroxychloroquine and for a prolonged duration in select patients (eg, those with valvulopathy/cardiomyopathy, acute endocarditis, or antiphospholipid antibodies) (Million 2013; Raoult 2020).

Persistent localized infection (eg, endocarditis, osteomyelitis, vascular infection, prosthetic joint infection): Oral: 100 mg every 12 hours in combination with hydroxychloroquine for ≥18 months, depending on site of infection and serologic response; in prosthetic valve disease or vascular infection, extend treatment to ≥24 months (CDC [Anderson 2013]; Raoult 2020).

Rhinosinusitis, acute bacterial (alternative agent for beta-lactam intolerance): Oral: 200 mg/day in 1 to 2 divided doses for 5 to 7 days (IDSA [Chow 2012]). Note: In uncomplicated acute bacterial rhinosinusitis, initial observation and symptom management without antibiotic therapy is appropriate in most patients (ACP/CDC [Harris 2016]).

Rocky Mountain spotted fever: Oral, IV: 100 mg twice daily for 5 to 7 days or for at least 3 days after fever subsides, whichever is longer; initiate treatment as soon as possible. Severe or complicated disease may require longer treatment (CDC [Biggs 2016]). Note: A loading dose of 200 mg IV is recommended for critically ill patients (Sexton 2019b).

Rosacea, moderate to severe or unresponsive to topical therapy: Oral:

Traditional dosing (off-label dose): Initial: 50 to 100 mg twice daily for 4 to 12 weeks; may follow with a topical agent and/or subantimicrobial doxycycline dosing for long-term management. Alternatively, may initiate therapy with subantimicrobial dosing (Akhyani 2008; Maier 2021).

Subantimicrobial dosing: 40 mg once daily (delayed release; Oracea) or 20 mg twice daily (immediate release) (Sanchez 2005).

Sexually transmitted infections:

Cervicitis, empiric therapy: Oral: 100 mg twice daily for 7 days (CDC [Workowski 2015]) or 200 mg delayed release once daily for 7 days (Geisler 2012); give in combination with ceftriaxone if the patient is at high risk for gonorrhea, if follow up is a concern, or if local prevalence is elevated (>5%) (CDC [Workowski 2015]; Powell 2021).

Epididymitis, acute (off-label use): Empiric therapy for chlamydia and gonorrhea: Oral: 100 mg twice daily for 10 days with single dose of ceftriaxone (CDC [Workowski 2015]). Note: An alternative regimen is recommended in patients who practice insertive anal sex (Eyre 2021; Hsu 2021).

Granuloma inguinale (donovanosis) (alternative agent): Oral: 100 mg twice daily for at least 3 weeks and until all lesions have healed. Note: If symptoms do not improve within the first few days of therapy, another agent (eg, aminoglycoside) can be added (CDC [Workowski 2015]).

Lymphogranuloma venereum: Oral: 100 mg twice daily for 21 days (CDC [Workowski 2015]).

Pelvic inflammatory disease (off-label use):

Inpatient (severe PID): IV, Oral: 100 mg every 12 hours in combination with cefoxitin or cefotetan; transition to oral therapy after >24 hours improvement to complete a 14-day total course. If pelvic abscess, anaerobic coverage is warranted (CDC [Workowski 2015]).

Outpatient (mild to moderate PID): Oral: 100 mg every 12 hours for 14 days in combination with a single dose of ceftriaxone (preferred) (Wiesenfeld 2021) or single dose of cefoxitin plus oral probenecid or other third generation cephalosporin; if Trichomonas vaginalis or recent uterine instrumentation, add metronidazole (CDC [Workowski 2015]).

Proctitis, acute or proctocolitis (off-label use): Empiric or pathogen-directed therapy for chlamydia and/or gonorrhea: Oral: 100 mg twice daily for 7 days plus a single dose of ceftriaxone. Note: Provide 21 days of doxycycline if polymerase chain reaction (PCR) for lymphogranuloma venereum (LGV) confirmed or as presumptive therapy for LGV if patient has severe rectal symptoms (eg, bloody discharge, perianal ulcers, or mucosal ulcers), and either a positive rectal chlamydia NAAT or HIV infection. Additional coverage for herpes simplex virus is warranted in patients with perianal or mucosal ulcers (CDC [Workowski 2015]).

Syphilis, penicillin-allergic patients: Note: Limited data support use of alternatives to penicillin and close serologic and clinical follow up is warranted (CDC [Workowski 2015]; Hicks 2021).

Early syphilis (primary, secondary, and early latent): Oral: 100 mg twice daily for 14 days (CDC [Workowski 2015]).

Late syphilis (late latent): Oral: 100 mg twice daily for 28 days (CDC [Workowski 2015]).

Urethritis, empiric therapy: Oral: 100 mg twice daily for 7 days; give in combination with ceftriaxone if there is microscopic evidence of gonococcal urethritis or if there is high clinical suspicion for gonococcal infection (Bachmann 2021; CDC [Workowski 2015]).

Skin and soft tissue infection:

Cellulitis, nonpurulent with risk for methicillin-resistant S. aureus: Oral: 100 mg twice daily in combination with an additional agent (eg, amoxicillin, cephalexin) for coverage of beta-hemolytic streptococci (IDSA [Stevens 2014]; Spelman 2021).

Cellulitis, purulent or abscess: Oral: 100 mg twice daily. Note: Systemic antibiotics only indicated for abscess in certain instances (eg, immunocompromised patients, signs of systemic infection, large or multiple abscesses, indwelling device, high risk for adverse outcome with endocarditis). If at risk for gram-negative bacilli, use in combination with an appropriate agent (IDSA [Stevens 2014]; Spelman 2021).

Duration: Treat for ≥5 days but may extend up to 14 days depending on severity and clinical response (IDSA [Stevens 2014]; Spelman 2021).

Impetigo or ecthyma if methicillin-resistant S. aureus is suspected or confirmed: Note: For impetigo, reserve systemic therapy for patients with numerous lesions or in outbreak settings to decrease transmission (IDSA [Stevens 2014]).

Oral: 100 mg twice daily for 7 days (Baddour 2021c; IDSA [Stevens 2014]).

Surgical prophylaxis, uterine evacuation (induced abortion or pregnancy loss) (off-label use): Oral: 200 mg as a single dose 1 hour prior to uterine aspiration (ACOG 195 2018); may be administered up to 12 hours before the procedure (Achilles 2011). Note: The optimal dosing regimen has not been established; various protocols are in use (Achilles 2011; RCOG 2015; White 2018; White 2019).

Tularemia (Francisella tularensis):

Treatment (mild infection) (alternative agent): Oral: 100 mg twice daily for 14 to 21 days (IDSA [Stevens 2014]; Penn 2020).

Postexposure prophylaxis (nonbioterrorism event, high-risk exposure): Oral: 100 mg twice daily for 14 days (Penn 2020).

Bioterrorism event: Note: Consult public health officials for event-specific recommendations.

Mass casualty management or postexposure prophylaxis (when used as a biological weapon): Oral: 100 mg twice daily for 14 days (Dennis 2001).

Contained casualty management (when used as a biological weapon): IV (may transition to oral if clinically appropriate): 100 mg every 12 hours for 14 to 21 days (Dennis 2001).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Renal Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

IV, Oral:

Mild to severe impairment: No dosage adjustment necessary (Alestig 1973; Lee 1972).

Hemodialysis, intermittent (thrice weekly): Poorly dialyzed (0% to 5%); no supplemental dose or dosage adjustment necessary (Houin 1983; Lee 1972; Letteri 1973).

Peritoneal dialysis: Poorly dialyzed; no dosage adjustment necessary (Letteri 1973).

CRRT: No dosage adjustment necessary (Heintz 2009).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (expert opinion).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

(For additional information see "Doxycycline: Pediatric drug information")

Note: Doxycycline is available as hyclate, monohydrate, and calcium salts. All doses are expressed as doxycycline base. Doxycycline was traditionally avoided in ages <8 years, but use has more recently been accepted for short courses (≤14 to 21 days) for all ages when necessary (Bradley 2021; IDSA/AAN/ACR [Lantos 2021]; Red Book [AAP 2021]).

General dosing:

Children and Adolescents: Oral, IV: 2.2 mg/kg/dose every 12 hours; maximum dose: 100 mg/dose.

Acne vulgaris, moderate to severe, treatment: Limited data available: Children ≥8 years and Adolescents: Oral: 50 to 100 mg once or twice daily or 150 mg once daily (Eichenfeld 2013).

Anthrax (AAP [Bradley 2014]): Note: Consult public health officials for event-specific recommendations.

Prophylaxis; postexposure (inhalation or cutaneous); prior to susceptibility testing or penicillin-resistant strains: Note: Doxycycline is a preferred option or ciprofloxacin: Infants, Children, and Adolescents: Treatment duration: 60 days.

Patient weight <45 kg: Oral: 2.2 mg/kg/dose every 12 hours.

Patient weight ≥45 kg: Oral: 100 mg every 12 hours.

Treatment; susceptible strains:

Cutaneous infection without systemic involvement: Note: Doxycycline is an option if first-line therapy (ie, ciprofloxacin) is unavailable or patient unable to tolerate; for naturally-occurring infection, usual treatment duration is 7 to 10 days; in the event of biological weapon exposure, additional therapy (as prophylaxis for inhaled spores) is necessary for a total course of 60 days from onset of illness.

Infants, Children, and Adolescents:

Patient weight <45 kg: Oral: 2.2 mg/kg/dose every 12 hours.

Patient weight ≥45 kg: Oral: 100 mg every 12 hours.

Systemic anthrax, excluding meningitis: Note: Not recommended for meningitis or disseminated infection when meningitis cannot be ruled out. Doxycycline is an alternative to clindamycin as protein synthesis inhibitor and should be used in combination with a bactericidal antimicrobial (eg, fluoroquinolone, carbapenem, vancomycin). Duration of therapy at least 14 days or longer until patient clinically stable; additional therapy (as prophylaxis for inhaled spores) is necessary for a total course of 60 days from onset of illness.

Infants, Children, and Adolescents:

Patient weight <45 kg:

Initial: IV: Loading dose: 4.4 mg/kg once, then 2.2 mg/kg/dose every 12 hours; may transition to oral therapy for patients without signs of active infection who are able to tolerate oral therapy and patient/caregiver adherent to therapy.

Step-down: Oral: 2.2 mg/kg/dose every 12 hours.

Patient weight ≥45 kg:

Initial: IV: Loading dose: 200 mg once, then 100 mg every 12 hours; may transition to oral therapy for patients without signs of active infection who are able to tolerate oral therapy and patient/caregiver adherent to therapy.

Step-down: Oral: 100 mg every 12 hours.

Brucellosis: Limited data available: Children ≥8 years and Adolescents: Oral: 2.2 mg/kg/dose twice daily for at least 6 weeks; maximum dose: 100 mg/dose; use in combination with rifampin; for serious infections, gentamicin should be added for initial 1 to 2 weeks and therapy may be extended for up to 4 to 6 months (Bradley 2021; Red Book [AAP 2021]).

Chlamydial infections, uncomplicated (sexually transmitted C. trachomatis):

Children ≥8 years: Oral: 2.2 mg/kg/dose twice daily for 7 days. Maximum dose: 100 mg/dose (Bradley 2021).

Adolescents: Oral: 100 mg twice daily for 7 days (CDC [Workowski 2015]).

Lyme disease (Borrelia spp. infection): Limited data available:

Prophylaxis, postexposure: Infants, Children, and Adolescents: Oral: 4.4 mg/kg/dose as a single dose; maximum dose: 200 mg/dose. Note: Prophylaxis is used only in patients who meet all of the following criteria for a high-risk bite: Ixodes spp. tick attached for ≥36 hours, prophylaxis can be given within 72 hours of tick removal, and tick bite occurred in a highly endemic area (ie, local rate of Ixodes spp. tick infection with Borrelia burgdorferi is ≥20%) (IDSA/AAN/ACR [Lantos 2021]).

Treatment: Infants, Children, and Adolescents: Oral: 2.2 mg/kg/dose twice daily; maximum dose: 100 mg/dose. Duration of therapy depends on clinical syndrome; treat erythema migrans for 10 days; borrelial lymphocytoma for 14 days; meningitis, radiculopathy, cranial nerve palsy, or carditis for 14 to 21 days; arthritis (initial, recurrent, or refractory) for 28 days; and acrodermatitis chronica atrophicans for 21 to 28 days (IDSA/AAN/ACR [Lantos 2021]).

Malaria:

Prophylaxis: Children ≥8 years and Adolescents: Oral: 2.2 mg/kg/dose once daily starting 1 to 2 days before travel to the area with endemic infection, continuing daily during travel and for 4 weeks after leaving endemic area; maximum daily dose: 100 mg/day (CDC [Tan 2019]).

Treatment: Children and Adolescents: Oral, IV: 2.2 mg/kg/dose twice daily for 7 days; maximum dose: 100 mg/dose; use in combination with quinine sulfate (plus primaquine for Plasmodium vivax) (CDC 2019). Note: Use of doxycycline in children <8 years should be reserved for when alternatives are not available or are not tolerated; benefits should outweigh risks.

Pneumonia, community-acquired; presumed or proven atypical infection (Mycoplasma pneumoniae, Chlamydophila pneumoniae): Children ≥8 years and Adolescents: Oral: 1 to 2 mg/kg/dose twice daily for 10 days (IDSA [Bradley 2011]).

Q fever (Coxiella burnetii) (preferred therapy): Children and Adolescents: Oral: 2.2 mg/kg/dose twice daily for 14 days; maximum dose: 100 mg/dose; in children <8 years with mild or uncomplicated disease, may consider treatment duration of 5 days, and if longer treatment required, may consider alternate therapy (trimethoprim/sulfamethoxazole) (CDC [Anderson 2013]).

Skin/soft tissue infections; MRSA or community-acquired cellulitis (purulent) (IDSA [Liu 2011]): Children ≥8 years and Adolescents:

≤45 kg: Oral: 2 mg/kg/dose every 12 hours for 5 to 10 days.

>45 kg: Oral: 100 mg twice daily for 5 to 10 days.

Tickborne rickettsial disease (Rocky Mountain spotted fever), ehrlichiosis, or anaplasmosis: Children and Adolescents: Oral, IV: 2.2 mg/kg/dose every 12 hours; maximum dose: 100 mg/dose; treat for minimum of 5 to 7 days; continue for at least 3 days after defervescence and clinical improvement observed. Severe or complicated disease may require longer treatment; anaplasmosis should be treated for 10 days (CDC [Biggs 2016]).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Renal Impairment: Pediatric

Children and Adolescents: IV, Oral: Limited data available:

Mild to severe kidney impairment: Based on adult information, no dosage adjustment is necessary (Alestig 1973; Lee 1972).

Hemodialysis, intermittent (thrice weekly): Poorly dialyzed (0% to 5%); based on adult information, no supplemental dose or dosage adjustment necessary (Houin 1983; Lee 1972; Letteri 1973).

Peritoneal dialysis: Poorly dialyzed; based on adult information, no dosage adjustment necessary (Letteri 1973).

Continuous renal replacement therapy (CRRT): Based on adult information, no dosage adjustment necessary (Heintz 2009).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Geriatric

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral, as hyclate [strength expressed as base]:

Morgidox: 50 mg, 100 mg [contains brilliant blue fcf (fd&c blue #1)]

Vibramycin: 100 mg [contains brilliant blue fcf (fd&c blue #1)]

Generic: 50 mg, 100 mg

Capsule, Oral, as monohydrate [strength expressed as base]:

Mondoxyne NL: 50 mg [contains fd&c yellow #10 (quinoline yellow)]

Mondoxyne NL: 75 mg [DSC]

Mondoxyne NL: 75 mg, 100 mg [contains fd&c yellow #10 (quinoline yellow)]

Monodox: 75 mg [DSC], 100 mg [DSC]

Okebo: 75 mg [DSC], 100 mg [DSC]

Generic: 50 mg, 75 mg, 100 mg, 150 mg

Capsule Delayed Release, Oral, as monohydrate [strength expressed as base]:

Oracea: 40 mg

Generic: 40 mg

Kit, Combination, as hyclate [strength expressed as base]:

Morgidox: 1 x 50 mg [DSC], 1 x 100 mg, 2 x 100 mg [contains brilliant blue fcf (fd&c blue #1), cetyl alcohol, edetate (edta) disodium]

Solution Reconstituted, Intravenous, as hyclate [strength expressed as base]:

Generic: 100 mg (1 ea)

Solution Reconstituted, Intravenous, as hyclate [strength expressed as base, preservative free]:

Doxy 100: 100 mg (1 ea)

Generic: 100 mg (1 ea)

Suspension Reconstituted, Oral, as monohydrate:

Generic: 25 mg/5 mL (60 mL)

Suspension Reconstituted, Oral, as monohydrate [strength expressed as base]:

Vibramycin: 25 mg/5 mL (60 mL) [contains brilliant blue fcf (fd&c blue #1), methylparaben, propylparaben; raspberry flavor]

Generic: 25 mg/5 mL (60 mL)

Syrup, Oral, as calcium [strength expressed as base]:

Vibramycin: 50 mg/5 mL (473 mL) [contains butylparaben, propylene glycol, propylparaben, sodium metabisulfite]

Vibramycin: 50 mg/5 mL (473 mL [DSC]) [contains butylparaben, propylene glycol, propylparaben, sodium metabisulfite; raspberry-apple flavor]

Tablet, Oral, as hyclate [strength expressed as base]:

Acticlate: 75 mg [contains brilliant blue fcf (fd&c blue #1), fd&c yellow #6 (sunset yellow)]

Acticlate: 150 mg [scored; contains fd&c blue #2 (indigotine)]

TargaDOX: 50 mg [contains fd&c blue #2 (indigotine), fd&c yellow #6 (sunset yellow)]

Generic: 20 mg, 50 mg, 75 mg, 100 mg, 150 mg

Tablet, Oral, as monohydrate [strength expressed as base]:

Avidoxy: 100 mg [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Generic: 50 mg, 75 mg, 100 mg, 150 mg

Tablet Delayed Release, Oral, as hyclate [strength expressed as base]:

Doryx: 50 mg [contains corn starch]

Doryx: 80 mg, 200 mg [scored; contains corn starch]

Doryx MPC: 120 mg [contains corn starch]

Soloxide: 150 mg [DSC]

Generic: 50 mg, 75 mg, 80 mg, 100 mg, 150 mg, 200 mg

Generic Equivalent Available: US

May be product dependent

Dosage Forms Considerations

Morgidox kits contain doxycycline capsules 100 mg, plus AcuWash moisturizing Daily Cleanser

NizAzel Doxy kits contain doxycycline tablets 100 mg, plus NicAzel FORTE dietary supplement tablets

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Periostat: 20 mg

Capsule, Oral, as hyclate [strength expressed as base]:

Generic: 100 mg

Capsule Delayed Release, Oral, as monohydrate [strength expressed as base]:

Apprilon: 40 mg

Tablet, Oral, as hyclate [strength expressed as base]:

Generic: 100 mg

Administration: Adult

Oral administration is preferable unless patient has significant nausea and vomiting; IV and oral routes are bioequivalent.

Oral: In general, administer with meals to decrease GI upset; however, some manufacturer labeling recommends administration on an empty stomach (see below). Administer capsules and tablets with at least 8 ounces (240 mL) of water and have patient sit up for at least 30 minutes after taking to reduce the risk of esophageal irritation and ulceration.

Acticlate: Swallow capsule whole; do not break, open, crush, dissolve, or chew. The 150 mg tablet may be broken into 2/3 or 1/3 to provide a 100 mg and 50 mg strength, respectively.

Doxycycline 20 mg tablet, Oracea, Apprilon [Canadian product]: Administer on an empty stomach 1 hour before or 2 hours after meals.

Doryx: May be administered by carefully breaking up the tablet and sprinkling tablet contents on a spoonful of cold applesauce. The delayed-release pellets must not be crushed or damaged when breaking up tablet. Should be administered immediately after preparation and without chewing; follow with a cool 8-ounce (240 mL) glass of water to ensure complete swallowing. If applesauce/pellet mixture is not administered immediately, discard (do not store for future use).

Doryx MPC: Do not chew or crush tablets.

Periostat [Canadian product]: Administer 1 hour before breakfast and evening meal.

Bariatric surgery: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate.

Capsule, delayed release: Delayed-release capsule may not be opened. Switch to IR formulation (capsule, tablet, or oral suspension) at closest possible dose.

Tablet, extended release: Delayed-release tablet can be cut into small pieces but not crushed.

IV: Infuse IV doxycycline over 1 to 4 hours. Avoid extravasation. Prolonged IV administration may cause thrombophlebitis. Oral administration is preferable unless patient has significant nausea and vomiting; IV and oral routes are bioequivalent.

Intrapleural (off-label route): Instill diluted doxycycline (combined with or following instillation of a local anesthetic) into chest tube; clamp chest tube for 2 hours (Porcel 2006; Robinson 1993).

Administration: Pediatric

Oral: Administer capsules or tablets with adequate amounts of fluid and remain in an upright position following administration (to avoid throat irritation); may be administered with food or milk to decrease GI upset (though absorption may be slightly reduced). Shake suspension well before use.

Acticlate:

Capsule: Swallow capsule whole; do not break, open, crush, dissolve, or chew the capsule.

Tablet (150 mg): May be broken into 1/3 to provide 50 mg dose or 2/3 to provide 100 mg/dose.

Doryx: May break up the tablet and sprinkle the delayed-release pellets on a spoonful of applesauce. Do not crush or damage the delayed-release pellets; loss or damage of pellets prevents using the dose. Swallow the Doryx/applesauce mixture immediately without chewing. Discard mixture if it cannot be used immediately.

Parenteral: For IV use only; administer over 1 to 4 hours; avoid rapid infusion.

Use: Labeled Indications

Acne: Adjunctive therapy in severe acne.

Actinomycosis: Treatment of actinomycosis caused by Actinomyces israelii when penicillin is contraindicated.

Acute intestinal amebiasis: Adjunct to amebicides in acute intestinal amebiasis.

Anthrax, including inhalational anthrax (postexposure): Treatment of anthrax caused by Bacillus anthracis, including inhalational (postexposure) prophylaxis; to reduce the incidence or progression of disease following exposure to aerosolized B. anthracis.

Cholera: Treatment of cholera infections caused by Vibrio cholerae.

Clostridium: Treatment of infections caused by Clostridium spp. when penicillin is contraindicated.

Gram-negative infections: Treatment of infections caused by Escherichia coli, Klebsiella aerogenes (formerly Enterobacter aerogenes), Shigella spp., Acinetobacter spp., Klebsiella spp. (respiratory and urinary infections), and Bacteroides spp.; Neisseria meningitidis (when penicillin is contraindicated).

Gram-positive infections: Treatment of infections caused by Streptococcus spp., when susceptible.

Listeriosis: Treatment of listeriosis due to Listeria monocytogenes when penicillin is contraindicated.

Malaria, prophylaxis: Prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (under 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine-resistant strains.

Mycoplasma pneumoniae: Treatment of infections caused by Mycoplasma pneumoniae.

Ophthalmic infections: Treatment of inclusion conjunctivitis or trachoma caused by Chlamydia trachomatis.

Periodontitis (20 mg tablet and capsule [Periostat (Canadian product)] only): Adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in patients with adult periodontitis.

Relapsing fever: Treatment of relapsing fever caused by Borrelia recurrentis.

Respiratory tract infections: Treatment of respiratory infections caused by Haemophilus influenzae, Klebsiella spp., or Mycoplasma pneumoniae; treatment of upper respiratory tract infections caused by Streptococcus pneumoniae; respiratory infections caused by Staphylococcus aureus (doxycycline is not the drug of choice in the treatment of any type of staphylococcal infection).

Rickettsial infections: Treatment of Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever (Coxiella burnetii), rickettsialpox, and tick fevers caused by Rickettsiae.

Rosacea (Oracea, Apprilon [Canadian product] only): Treatment of only inflammatory lesions (papules and pustules) of rosacea in adults.

Sexually transmitted infections: Treatment of lymphogranuloma venereum and uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis; granuloma inguinale (donovanosis) caused by Klebsiella granulomatis; chancroid caused by Haemophilus ducreyi; nongonococcal urethritis caused by Ureaplasma urealyticum; when penicillin is contraindicated, syphilis caused by Treponema pallidum.

Skin and soft tissue infections (Avidoxy only): Treatment of skin and soft tissue infections caused by S. aureus (doxycycline is not the drug of choice in the treatment of any type of staphylococcal infection).

Vincent infection: Treatment of Vincent infection caused by Fusobacterium fusiforme when penicillin is contraindicated.

Yaws: Treatment of yaws caused by Treponema pallidum subspecies pertenue when penicillin is contraindicated.

Zoonotic infections: Treatment of psittacosis (ornithosis) caused by Chlamydophila psittaci; plague due to Yersinia pestis; tularemia caused by Francisella tularensis; brucellosis caused by Brucella spp. (in conjunction with streptomycin); bartonellosis caused by Bartonella bacilliformis; infections caused by Campylobacter fetus.

Use: Off-Label: Adult

Anaplasmosis and ehrlichiosis; Bite wound infection (animal or human bite); Chronic obstructive pulmonary disease, acute exacerbation; Epididymitis, acute; Hidradenitis suppurativa; Lyme disease (Borrelia spp. infection); Malaria, treatment; Otitis media, acute; Pelvic inflammatory disease; Pleurodesis, chemical (sclerosing agent for pleural effusion); Proctitis, acute or proctocolitis; Prosthetic joint infection; Surgical prophylaxis, uterine evacuation (induced abortion or pregnancy loss)

Medication Safety Issues
Sound-alike/look-alike issues:

Doxycycline may be confused with dicyclomine, doxepin, doxylamine

Doxy100 may be confused with Doxil

Monodox may be confused with Maalox

Oracea may be confused with Orencia

Vibramycin may be confused with vancomycin, Vibativ

International issues:

Oracea (US brand name) is marketed in Canada under the brand name Apprilon

Adverse Reactions (Significant): Considerations
Bone growth suppression

Bone growth suppression, as evidenced by growth retardation (fibula), has been reported in premature infants treated with tetracycline; growth restriction up to 40% has been associated with oral tetracycline therapy but is reversible when short-term treatment is discontinued. Upon discontinuation of tetracycline, rapid compensatory bone growth is observed (Ref). There are limited/no data with doxycycline; therefore, the risk for bone growth suppression is extrapolated from data with tetracycline.

Mechanism: Dose-related; tetracycline binds to calcium in growing bones and negatively affects calcium orthophosphate metabolism (Ref); doxycycline appears to bind to calcium less than tetracycline (Ref).

Onset: Rapid to intermediate; deposition of tetracycline in bone has been shown after one dose and treatment with tetracycline for 9 to 12 days has resulted in restricted bone growth (Ref).

Risk factors:

• Age: Premature infants (Ref)

• Dose; tetracycline 25 mg/kg/dose every 6 hours in premature infants (Ref)

Esophageal injury

Esophagitis, esophageal ulcer, and/or esophageal stenosis may occur; patients with sudden onset of chest pain, dysphagia, odynophagia, and/or retrosternal pain may require assessment (Ref). Esophagitis is more frequent with doxycycline than minocycline (Ref).

Mechanism: Local caustic injury due to direct local contact as doxycycline has a pH <3 (Ref).

Onset: Varied; 3 to 12 days after initiation. In treatment of chronic conditions such as acne vulgaris, it can occur any time during treatment (Ref).

Risk factors:

• Administration at bedtime or prior to lying down (Ref)

• Altered esophageal anatomy or underlying esophageal strictures

• Inadequate fluid intake with administration (Ref)

• Preexisting esophageal disorders (eg, gastroesophageal reflux disease)

Photosensitivity

Doxycycline is a photosensitizing agent that may cause skin photosensitivity reactions ranging from mild sunburn-like reactions to photodermatitis (Ref). Phototoxic reactions are restricted to exposed skin, usually develop shortly after sun exposure and appear to be dose-related (Ref). Photo-onycholysis has also been reported with tetracyclines (Ref). The main wavelength causing doxycycline’s phototoxic reactions is UVA1 (340-400 nm) (Ref). Chronic tetracycline use (>2 months) may increase the risk of basal cell carcinoma by 11% (Ref).

Mechanism: Doxycycline is activated by the radiation in the long UVA1 spectrum (340-400 nm), increasing sensitivity to sunlight (Ref).

Onset: Photosensitivity: Occurs <24 hours after sun exposure (Ref).

Risk factors:

• Children even at very low doses (20 mg daily) may have increased susceptibility (Ref)

• Fitzpatrick skin types I and II (white, always burns, never tans or tans minimally) (Ref)

• Higher doses (Ref)

• Lack of adherence to suggested sun avoidance, sun-protective clothing, and broad- spectrum sunscreen (UVA and UVB) (Ref)

• Living in a country with high solar radiation; even low doses can precipitate a reaction (Ref)

• Use of sunscreens with primary UVA protection offered by oxybenzone (absorbs shorter UVA radiation) (Ref)

Skin hyperpigmentation/dental discoloration

Doxycycline may induce diffuse skin hyperpigmentation (brown, bluish-grey, black discoloration) including nails, skin of hands, arms, legs, dorsal side of feet, interdigital areas, or around scars. There has been controversy around the risk of dental staining (staining of tooth) and enamel hypoplasia with doxycycline use during tooth development; however, studies have not validated these issues and most recommend short-term use (<21 days) in children regardless of age (Ref). Local pain with the change in pigment has been reported (Ref). Many of these patients were receiving doxycycline at higher doses and for prolonged periods of time as in treatment of Q fever. For treatment of Q fever, doxycycline is administered concurrently with hydroxychloroquine, which also may cause skin hyperpigmentation (Ref). This hyperpigmentation may be more prevalent with use of minocycline and associated with a greater variety of tissues. Partially reversible or reversible within 1 to 12 months of discontinuation (Ref).

Mechanism: Doxycycline may mineralize tissue as it binds to calcium/iron to form a tetracycline-calcium orthophosphate complex and/or activate melanocytes in the upper dermis (Ref).

Onset: Varied; 2 weeks to 37 months (Ref).

Risk factors:

• High doses used in difficult to treat infections (Ref)

• Long-term use (eg, Q fever) (Ref)

• Pediatric: Treatment course >21 days (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Endocrine & metabolic: Increased lactate dehydrogenase (2%), increased serum glucose (1%)

Gastrointestinal: Abdominal distention (1%), abdominal pain (1%), diarrhea (5%), upper abdominal pain (2%), xerostomia (1%)

Genitourinary: Vulvovaginal candidiasis (Shapiro 1997)

Postmarketing:

Dermatologic: Erythema multiforme (Shapiro 1997), erythematous rash, exfoliative dermatitis, maculopapular rash, onycholysis (photo-onycholysis skin hyperpigmentation; chronic use) (Dowlati 2015), skin hyperpigmentation (rare: <1%) (Akcam 2005; Keijmel 2015), skin photosensitivity (more frequent to common: ≥4% to ≥10%) (Goetze 2017; Lebrun 2012; Shapiro 1997), Stevens-Johnson syndrome (rare: <1%) (Cac 2007; Shapiro 1997), urticaria (Shapiro 1997)

Endocrine & metabolic: Growth retardation (fibula; based on tetracycline data) (Cohlan 1963)

Gastrointestinal: Anorexia, Clostridioides difficile associated diarrhea (not associated with increased risk) (Deshpanda 2013; Tariq 2018), enamel hypoplasia (Stultz 2019), esophageal stenosis (rare: <1%) (Bonavina 1989), esophageal ulcer (rare: <1%) (Guo 2019), esophagitis (rare: <1%) (Kim 2014), glossitis, nausea (Shapiro 1997), staining of tooth (Stultz 2019), vomiting (Shapiro 1997)

Hematologic & oncologic: Basal cell carcinoma of skin (chronic use) (Li 2018)

Hepatic: Hepatotoxicity (rare: <1%; cholestatic, hepatocellular, or mixed hepatitis; may be accompanied by DRESS symptoms) (Bjornsson 1997; Heaton 2007; LiverTox 2019)

Hypersensitivity: Angioedema (Shapiro 1997), hypersensitivity reaction (Shapiro 1997), nonimmune anaphylaxis (Raeder 1984), serum sickness (Shapiro 1997)

Immunologic: Drug reaction with eosinophilia and systemic symptoms (Lebrun-Vignes 2012)

Nervous system: Bulging fontanel (based on tetracycline data) (Fields 1961; Opfer 1963), idiopathic intracranial hypertension (causality not established; females of childbearing age who are overweight or have a history of intracranial hypertension may be at greater risk)

Renal: Increased blood urea nitrogen

Contraindications

Hypersensitivity to doxycycline, other tetracyclines, or any component of the formulation.

Doxytab [Canadian product]: Additional contraindications: Myasthenia gravis; concurrent use with isotretinoin.

Periostat, Apprilon [Canadian products]: Additional contraindications: Use in infants and children <8 years of age or during second or third trimester of pregnancy; breast-feeding.

Warnings/Precautions

Concerns related to adverse effects:

• Increased BUN: May be associated with increases in BUN secondary to antianabolic effects; this does not occur with use of doxycycline in patients with renal impairment.

• Intracranial hypertension: Intracranial hypertension (pseudotumor cerebri) has been reported; headache, blurred vision, diplopia, vision loss, and/or papilledema may occur. Women of childbearing age who are overweight or have a history of intracranial hypertension are at greater risk. Intracranial hypertension typically resolves after discontinuation of treatment; however, permanent visual loss is possible. If visual symptoms develop during treatment, prompt ophthalmologic evaluation is warranted. Intracranial pressure can remain elevated for weeks after drug discontinuation; monitor patient until stable.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection.

Disease-related concerns

• Oral candidiasis: Safety and effectiveness have not been established for treatment of periodontitis in patients with coexistent oral candidiasis; use with caution in patients with a history or predisposition to oral candidiasis.

Special populations:

• Pediatric: May cause tissue hyperpigmentation; manufacturer states to use in children ≤8 years of age only when the potential benefits outweigh the risks in severe or life threatening conditions (eg, anthrax, Rocky Mountain spotted fever), particularly when there are no alternative therapies. Limited use between 6 to 7 years of age has minimal effect on the color of permanent incisors (CDC [Biggs 2016]). Recommended in prevention and treatment of anthrax (AAP [Bradley 2014]), treatment of tickborne rickettsial diseases (CDC [Biggs 2016]), and Q fever (CDC [Anderson 2013]).

Dosage form specific issues:

• Oracea, Apprilon [Canadian product]: Should not be used for the treatment or prophylaxis of bacterial infections because the lower dose of drug per capsule may be subefficacious and promote resistance.

• Sulfite sensitivity: Syrup may contain sodium metabisulfite, which may cause allergic reactions in certain individuals (eg, asthmatic patients).

Other warnings/precautions:

• Appropriate use: Acne: The American Academy of Dermatology acne guidelines recommend doxycycline as adjunctive treatment for moderate and severe acne and forms of inflammatory acne that are resistant to topical treatments. Concomitant topical therapy with benzoyl peroxide or a retinoid should be administered with systemic antibiotic therapy (eg, doxycycline) and continued for maintenance after the antibiotic course is completed (AAD [Zaenglein 2016]).

• Limitations of use: Malaria prophylaxis: Doxycycline does not completely suppress asexual blood stages of Plasmodium strains; does not suppress P. falciparum's sexual blood stage gametocytes. Patients completing a regimen may still transmit the infection to mosquitoes outside endemic areas.

Warnings: Additional Pediatric Considerations

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Metabolism/Transport Effects

None known.

Drug Interactions

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Antacids: May decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Monitor for decreased therapeutic effects of tetracyclines. Risk D: Consider therapy modification

Barbiturates: May decrease the serum concentration of Doxycycline. Risk C: Monitor therapy

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Tetracyclines. Risk C: Monitor therapy

Bismuth Subcitrate: May decrease the serum concentration of Tetracyclines. Management: Avoid administration of oral tetracyclines within 30 minutes of bismuth subcitrate administration. This is of questionable significance for at least some regimens intended to treat H. pylori infections. Risk D: Consider therapy modification

Bismuth Subsalicylate: May decrease the serum concentration of Tetracyclines. Management: Consider dosing tetracyclines 2 hours before or 6 hours after bismuth. The need to separate doses during Helicobacter pylori eradication regimens is questionable. Risk D: Consider therapy modification

Calcium Salts: May decrease the serum concentration of Tetracyclines. Management: If coadministration of oral calcium with oral tetracyclines cannot be avoided, consider separating administration of each agent by several hours. Risk D: Consider therapy modification

CarBAMazepine: May decrease the serum concentration of Doxycycline. Management: Consider increasing the doxycycline dose, or using another tetracycline derivative due to the potential for reduced doxycycline therapeutic effects when coadministered wth carbamazepine. If combined, monitor for reduced doxycyline efficacy. Risk D: Consider therapy modification

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Fosphenytoin: May decrease the serum concentration of Doxycycline. Management: Consider increasing the dose of doxycycline when initiating phenytoin, or using another tetracycline derivative to avoid this interaction. If coadministered, monitor for decreased therapeutic effects of doxycyline. Risk D: Consider therapy modification

Iron Preparations: Tetracyclines may decrease the absorption of Iron Preparations. Iron Preparations may decrease the serum concentration of Tetracyclines. Management: Avoid this combination if possible. Administer oral iron preparations at least 2 hours before, or 4 hours after, the dose of the oral tetracycline derivative. Monitor for decreased therapeutic effect of oral tetracycline derivatives. Risk D: Consider therapy modification

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Lanthanum: May decrease the serum concentration of Tetracyclines. Management: Administer oral tetracycline antibiotics at least two hours before or after lanthanum. Risk D: Consider therapy modification

Lithium: Tetracyclines may increase the serum concentration of Lithium. Risk C: Monitor therapy

Magnesium Dimecrotate: May interact via an unknown mechanism with Tetracyclines. Risk C: Monitor therapy

Magnesium Salts: May decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Risk D: Consider therapy modification

Mecamylamine: Tetracyclines may enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination

Methoxyflurane: Tetracyclines may enhance the nephrotoxic effect of Methoxyflurane. Risk X: Avoid combination

Mipomersen: Tetracyclines may enhance the hepatotoxic effect of Mipomersen. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease the serum concentration of Tetracyclines. Management: Avoid this combination if possible. If coadministration cannot be avoided, administer the polyvalent cation-containing multivitamin at least 2 hours before or 4 hours after the tetracycline derivative. Monitor for decreased tetracycline effects. Risk D: Consider therapy modification

Multivitamins/Minerals (with AE, No Iron): May decrease the serum concentration of Tetracyclines. Management: If coadministration of a polyvalent cation-containing multivitamin with oral tetracyclines cannot be avoided, administer the polyvalent cation-containing multivitamin either 2 hours before or 4 hours after the tetracycline product. Risk D: Consider therapy modification

Neuromuscular-Blocking Agents: Tetracyclines may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Penicillins: Tetracyclines may diminish the therapeutic effect of Penicillins. Risk C: Monitor therapy

Phenytoin: May decrease the serum concentration of Doxycycline. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Proton Pump Inhibitors: May decrease the bioavailability of Doxycycline. Risk C: Monitor therapy

Quinapril: May decrease the serum concentration of Tetracyclines. Risk C: Monitor therapy

Retinoic Acid Derivatives: Tetracyclines may enhance the adverse/toxic effect of Retinoic Acid Derivatives. The development of pseudotumor cerebri is of particular concern. Risk X: Avoid combination

RifAMPin: May decrease the serum concentration of Doxycycline. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Strontium Ranelate: May decrease the serum concentration of Tetracyclines. Management: In order to minimize any potential impact of strontium ranelate on tetracycline antibiotic concentrations, it is recommended that strontium ranelate treatment be interrupted during tetracycline therapy. Risk X: Avoid combination

Sucralfate: May decrease the absorption of Tetracyclines. Management: Administer most tetracycline derivatives at least 2 hours prior to sucralfate in order to minimize the impact of this interaction. Administer oral omadacycline 4 hours prior to sucralfate. Risk D: Consider therapy modification

Sucroferric Oxyhydroxide: May decrease the serum concentration of Tetracyclines. Management: Administer oral/enteral doxycycline at least 1 hour before sucroferric oxyhydroxide. Specific dose separation guidelines for other tetracyclines are not presently available. No interaction is anticipated with parenteral administration of tetracyclines. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Tetracyclines may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Food Interactions

Ethanol: Chronic ethanol ingestion may reduce the serum concentration of doxycycline.

Food: Doxycycline serum levels may be slightly decreased if taken with high-fat meal or milk. Administration with iron or calcium may decrease doxycycline absorption. May decrease absorption of calcium, iron, magnesium, zinc, and amino acids. Management: Administer Doryx and Doryx MPC without regard to meals. Administer Oracea and doxycycline 20 mg tablet on an empty stomach 1 hour before or 2 hours after meals.

Reproductive Considerations

Doxycycline can be detected in semen (Zakhem 2019). The manufacturer does not recommend use of doxycycline for the treatment of rosacea in males with female partners who plan to become pregnant.

Pregnancy Considerations

Tetracyclines cross the placenta (Mylonas 2011).

Therapeutic doses of doxycycline during pregnancy are unlikely to produce substantial teratogenic risk, but data are insufficient to say that there is no risk. In general, reports of exposure have been limited to short durations of therapy in the first trimester. Tetracyclines accumulate in developing teeth and long tubular bones (Mylonas 2011). Permanent discoloration of teeth (yellow, gray, brown) can occur following in utero exposure and is more likely to occur following long-term or repeated exposure.

Doxycycline is used for the treatment of Lyme disease. Vertical transmission from mother to fetus is not well documented; it is unclear if infection increases the risk of adverse pregnancy outcomes. A single prophylactic dose of doxycycline can be used in pregnant patients; the use of treatment doses should be individualized (IDSA/AAN/ACR [Lantos 2021]; Lambert 2020; SOGC [Smith 2020]). Doxycycline is the recommended agent for the treatment of Rocky Mountain spotted fever (RMSF) in pregnant patients (CDC [Biggs 2016]). For other indications, many guidelines consider use of doxycycline to be contraindicated during pregnancy, or to be a relative contraindication in pregnant patients if other agents are available and appropriate for use (CDC [Anderson 2013]; CDC 2020; CDC [Workowski 2015]; HHS [OI adult 2020]; IDSA [Stevens 2014]). Doxycycline should not be used for the treatment of acne or rosacea in pregnant patients (AAD [Zaenglein 2016]). When systemic antibiotics are needed for dermatologic conditions, other agents are preferred (Kong 2013; Murase 2014). As a class, tetracyclines are generally considered second-line antibiotics in pregnant patients and their use should be avoided (Mylonas 2011).

Breast-Feeding Considerations

Doxycycline is present in breast milk.

The relative infant dose (RID) of doxycycline is 6.14% when calculated using the highest average breast milk concentration located and compared to an infant therapeutic dose of 4.4 mg/kg/day.

In general, breastfeeding is considered acceptable when the RID is <10%; when an RID is >25% breastfeeding should generally be avoided (Anderson 2016; Ito 2000).

Using the highest average milk concentration (1.8 mcg/mL), the estimated daily infant dose via breast milk is 0.27 mg/kg/day. This milk concentration was obtained following maternal administration of a single oral dose of doxycycline 200 mg (Tokuda 1969). Concentrations of doxycycline in breast milk may increase with duration of therapy (Anderson 1991).

Oral absorption of doxycycline is not markedly influenced by simultaneous ingestion of milk; therefore, oral absorption of doxycycline by the breastfeeding infant would not be expected to be diminished by the calcium in the maternal milk.

The therapeutic use of doxycycline should be avoided during tooth development (children <8 years) unless there are no alternative therapies due to the potential for tissue hyperpigmentation, tooth enamel hypoplasia, or permanent tooth discoloration. Theoretically, this risk is also present in breastfeeding infants exposed to doxycycline via breast milk. Although breastfeeding is not specifically contraindicated, the effects of long-term exposure via breast milk are not known. According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. The World Health Organization (WHO) states that maternal use of doxycycline should be avoided if possible but that a single dose or the short-term use of doxycycline is probably safe; there exists a possibility of dental staining and inhibition of bone growth in the infant, especially with prolonged use (WHO 2002). In general, antibiotics that are present in breast milk may cause nondose-related modification of bowel flora. Monitor infants for GI disturbances, such as thrush and diarrhea (WHO 2002).

Current guidelines note that the short-term use of doxycycline for the treatment of RMSF is considered compatible with breastfeeding (CDC [Biggs 2016]). If used for the treatment or prophylaxis of malaria, breastfeeding during doxycycline therapy is considered compatible; however, the theoretical risk of dental staining and inhibition of long bone growth in the breastfeeding infant should be considered (WHO 2002). Breastfeeding is not recommended when doxycycline is being used for maternal treatment of acne (AAD [Zaenglein 2016]).

Dietary Considerations

Tetracyclines (in general): Take with food if gastric irritation occurs. While administration with food may decrease GI absorption of doxycycline by up to 20%, administration on an empty stomach is generally not recommended due to GI intolerance. Of currently available tetracyclines, doxycycline has the least affinity for calcium.

Doxycycline 20 mg tablet, Oracea, Apprilon [Canadian product]: Manufacturer states to take on an empty stomach 1 hour before or 2 hours after meals. Take with food if gastric irritation occurs.

Periostat [Canadian product]: Manufacturer states to take at least 1 hour before morning and evening meals. Take with food if gastric irritation occurs.

Some products may contain sodium.

Monitoring Parameters

CBC, renal and liver function tests periodically with prolonged therapy.

Patients with no risk factors for chronic Q fever should undergo clinical and serological evaluation 6 months after diagnosis of acute Q fever to identify possible progression to chronic disease. Postpartum women treated during pregnancy for acute Q fever, others who are at high risk for progression to chronic disease or when used as part of treatment for chronic Q fever infection unrelated to endocarditis or vascular infection (eg, osteoarticular infections or chronic hepatitis), assess serologic response at 3, 6, 12, 18, and 24 months after diagnosis of acute Q fever (or after delivery in pregnant women) (CDC [Anderson 2013]).

Mechanism of Action

Inhibits protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit(s) of susceptible bacteria; may also cause alterations in the cytoplasmic membrane

20 mg tablets and capsules (Periostat [Canadian product]): Proposed mechanism: Has been shown to inhibit collagenase activity in vitro. Also has been noted to reduce elevated collagenase activity in the gingival crevicular fluid of patients with periodontal disease. Systemic levels do not reach inhibitory concentrations against bacteria.

Pharmacodynamics and Pharmacokinetics

Absorption: Oral: Almost completely absorbed from the GI tract; average peak plasma concentration may be reduced ~20% (30% for Doryx MPC) by high-fat meal or milk

Distribution: Widely into body tissues and fluids including synovial, pleural, prostatic, seminal fluids, and bronchial secretions; saliva, aqueous humor, and CSF penetration is poor

Protein binding: >90%

Metabolism: Not hepatic; partially inactivated in GI tract by chelate formation

Bioavailability: Reduced at high pH; may be clinically significant in patients with gastrectomy, gastric bypass surgery or who are otherwise deemed achlorhydric

Half-life elimination: 18 to 22 hours; End-stage renal disease: 18 to 25 hours

Time to peak, serum: Oral: Immediate release: 1.5 to 4 hours; delayed release: 2.8 to 3 hours

Excretion: Feces (30%); urine (23% to 40%)

Pharmacodynamics and Pharmacokinetics: Additional Considerations

Renal function impairment: Excretion by the kidneys may fall as low as 1% to 5% in 72 hours in patients with CrCl <10 mL/minute.

Anti-infective considerations:

Parameters associated with efficacy: Time and concentration dependent, associated with 24-hour area under the curve (AUC24)/minimum inhibitory concentration (MIC); however, no specific goal AUC24/MIC has been identified (Agwuh 2006; Ambrose 2007; Cunha 2000; Smirnova 2011).

Expected drug exposure in normal renal function: AUC: Adults: Oral: 200 mg once daily for 1 dose, then 100 mg once daily: 12.7 ± 4.9 mg•hour/L (Schreiner 1985).

Postantibiotic effect: 0.7 to 2.8 hours, depending on organism (eg, S. aureus, S. pneumoniae, E. coli) (Cunha 2000).

Pricing: US

Capsule, delayed release (Doxycycline Oral)

40 mg (per each): $24.94

Capsule, delayed release (Oracea Oral)

40 mg (per each): $32.51

Capsules (Doxycycline Hyclate Oral)

50 mg (per each): $2.16 - $2.25

100 mg (per each): $0.38 - $9.62

Capsules (Doxycycline Monohydrate Oral)

50 mg (per each): $1.45 - $1.55

75 mg (per each): $16.40 - $16.92

100 mg (per each): $2.13 - $2.56

150 mg (per each): $24.65

Capsules (Mondoxyne NL Oral)

75 mg (per each): $15.20

100 mg (per each): $10.52

Capsules (Morgidox Oral)

100 mg (per each): $23.61

Capsules (Vibramycin Oral)

100 mg (per each): $1.08

Kit (Morgidox Combination)

1 x 100 mg (per each): $708.41

2 x 100 mg (per each): $1,131.72

Solution (reconstituted) (Doxy 100 Intravenous)

100 mg (per each): $25.20

Solution (reconstituted) (Doxycycline Hyclate Intravenous)

100 mg (per each): $20.00 - $30.20

Suspension (reconstituted) (Doxycycline Monohydrate Oral)

25 mg/5 mL (per mL): $0.38 - $0.44

Suspension (reconstituted) (Vibramycin Oral)

25 mg/5 mL (per mL): $0.83

Syrup (Vibramycin Oral)

50 mg/5 mL (per mL): $1.28

Tablet, EC (Doryx MPC Oral)

120 mg (per each): $15.00

Tablet, EC (Doryx Oral)

50 mg (per each): $14.22

80 mg (per each): $44.03

200 mg (per each): $52.64

Tablet, EC (Doxycycline Hyclate Oral)

50 mg (per each): $11.73 - $13.51

75 mg (per each): $10.22

80 mg (per each): $39.58

100 mg (per each): $3.52 - $13.12

150 mg (per each): $4.73 - $17.60

200 mg (per each): $13.92 - $50.01

Tablets (Acticlate Oral)

75 mg (per each): $44.10

150 mg (per each): $44.10

Tablets (Doxycycline Hyclate Oral)

20 mg (per each): $0.74 - $1.30

50 mg (per each): $13.20

75 mg (per each): $31.15 - $31.19

100 mg (per each): $0.84 - $6.15

150 mg (per each): $31.15 - $31.19

Tablets (Doxycycline Monohydrate Oral)

50 mg (per each): $2.89 - $3.36

75 mg (per each): $4.93 - $4.99

100 mg (per each): $4.23 - $4.92

150 mg (per each): $9.14

Tablets (TargaDOX Oral)

50 mg (per each): $16.48

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Abraxil (CL);
  • Adjusan (BE, NL);
  • Agidox (LK);
  • Alldox (ZW);
  • Amermycin (HK);
  • Apdox (BD);
  • Asdoxin (ET);
  • Azudoxat (DE);
  • Bactidox (PH);
  • Bassado (IT);
  • Biodoxi (IN);
  • Biomixin (MX);
  • Biomoxin (CR, DO, GT, HN, NI, PA, SV);
  • By-Mycin (IE);
  • Ciclonal (MX);
  • Clordox (BR);
  • Cyclidox (ZA);
  • Cyclindox (VN);
  • Cytragen (PH);
  • Dagramycine (LU);
  • Dentacline (KR);
  • Dentistar (KR);
  • Deoxymykoin (CZ);
  • Doc-100 (TZ);
  • Doinmycin (TW);
  • Dokat (TR);
  • Doksiciklin (HR);
  • Doksin (TR);
  • Domiekn (CR);
  • Domiken (DO, GT, HN, MX, NI, PA, SV);
  • Doryx (AU, NZ);
  • Dosil (ES);
  • Dotur (UY);
  • Doxat (CY, IQ, IR, JO, KW, LY, MT, OM, QA, SA, SY, VN, YE);
  • Doxicap (ZW);
  • Doxiclat (ES);
  • Doxicor (ID);
  • Doxikan (EG);
  • Doximed (FI);
  • Doximycin (FI);
  • Doxin (PH, TH);
  • Doxine (NZ);
  • Doxipil (ES);
  • Doxiplus (PE);
  • Doxitin (LV);
  • Doxman (LK);
  • Doxsig (AU);
  • Doxxkam (PH);
  • Doxy (LB);
  • Doxy 200 (LU);
  • Doxy A (BD);
  • Doxy Komb (LU);
  • Doxy M (EE);
  • Doxy SMB (LU);
  • Doxy-1 (IN);
  • Doxy-100 (DE, NZ);
  • Doxybene (CZ, UA);
  • Doxycap (HK, SG);
  • Doxycin (SA);
  • Doxyclin (ZW);
  • Doxycline (LU, TH);
  • Doxycyclin AL (HU);
  • Doxycycline (BE);
  • Doxycycline-Ethypharm (LU);
  • Doxycycline-Eurogenerics (LU);
  • Doxydar (BH, JO, QA, SA);
  • Doxydox (EG);
  • Doxyhexal (CZ, HU, LU);
  • Doxylag (BB, BF, BJ, BM, BS, BZ, CI, CY, ET, GH, GM, GN, GY, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, YE, ZM, ZW);
  • Doxylan (LV);
  • Doxylcap (TH);
  • Doxylets (LU);
  • Doxylin (AU, IL, NO, NZ);
  • Doxyline (SG);
  • Doxylis (FR);
  • Doxymycin (TW, ZA);
  • Doxymycine (LU);
  • Doxypharm (HU);
  • Dumoxin (CY, ID, IQ, IR, JO, KW, LY, OM, SA, SY, YE);
  • Duo Di (CN);
  • Duradox (AE, BH, KW, QA);
  • Efracea (BE, GB, IE, NL);
  • Empadoxine (ET);
  • Etidoxina (CO);
  • Frakas (AU);
  • Genobiotic-Doxi (MX);
  • Grandoxy (AE);
  • Granudoxy (CR, DO, FR, GT, HN, LU, NI, PA, SV);
  • Hiramicin (HR);
  • Impedox (BD);
  • Interdoxin (ID);
  • Lenteclin (ET);
  • Madoxy (TH);
  • Mardox (BD);
  • Medomycin (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, MY, NE, NG, SC, SD, SG, SL, SN, TN, TW, TZ, UG, ZM, ZW);
  • Medox (PH);
  • Microdox (LK, ZW);
  • Miraclin (IT);
  • Monocin (KR);
  • Monodox (CO);
  • Oracea (ES);
  • Periostat (GB);
  • Policycline (TH);
  • Radox (BF, BJ, CI, CY, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZM, ZW);
  • Remycin (BH, MT, TR, TW);
  • Retadox (LB);
  • Retens (MT);
  • Revidox (LK);
  • Servidoxine (EC);
  • Siadocin (TH);
  • Sigadoxin (PT);
  • Supracyclin (AT, CH, PE);
  • Supramycina (EC, PY);
  • Tabocine (AE, QA);
  • Tarocin (KW);
  • Tedoxy (PH);
  • Tenutan (BB, BM, BS, BZ, GY, JM, SR, TT);
  • Teradox (PH);
  • Teradoxin (ET);
  • Tolexine (FR, HK);
  • Tolexine Ge (FR);
  • Torymycin (TH);
  • Tremesal (VE);
  • Unidox (CY, IQ, IR, JO, KW, LY, NL, OM, PL, QA, RO, SA, SY, UA, YE);
  • Unidoxy (KR);
  • Veemycin (TH);
  • Verboril (AR);
  • Vibradox (DK, PT);
  • Vibramicina (AR, CL, CO, MX, PE, PT, UY, VE);
  • Vibramycin (AE, AT, AU, BB, BF, BG, BH, BJ, BM, BS, BZ, CH, CI, CY, DE, EG, ET, GB, GH, GM, GN, GR, GY, HK, HU, ID, IE, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, MY, NE, NG, NL, OM, PH, PK, QA, RU, SA, SC, SD, SE, SL, SN, SR, SY, TH, TN, TT, TZ, UG, YE, ZA, ZM, ZW);
  • Vibramycin N (KR);
  • Vibramycine (FR);
  • Vibratab (BE, LU);
  • Vibraveineuse (FR);
  • Vibravenos (AT, DE);
  • Viclorax (PE);
  • Vidoxy (KR);
  • Vivradoxil (MX);
  • Weibamycin (TW);
  • Withamycin (TW);
  • Xidox (MY);
  • Yong Xi (CN);
  • Zadorin (BB, BF, BJ, BM, BS, BZ, CI, CY, ET, GH, GM, GN, GY, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, YE, ZM, ZW)


For country abbreviations used in Lexicomp (show table)

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