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Therapeutic action
- Cycline antibacterial
Indications
- Cholera, uncomplicated cutaneous anthrax, louse-borne and tick-borne relapsing fevers, epidemic typhus and other rickettsioses, plague, brucellosis, leptospirosis, lymphogranuloma venereum
- Lymphatic filariasis, alternative to ivermectin in onchocerciasis
- Alternative to first-line treatments of treponematosis, atypical pneumonia (Mycoplasma pneumoniae, Chlamydophila pneumoniae), cervicitis and urethritis due to Chlamydia trachomatis (in combination with a treatment for gonorrhoea), donovanosis, syphilis
Forms and strengths
- 100 mg tablet
Dosage
Louse-borne relapsing fever, epidemic typhus, cholera
- Child: 4 mg/kg (max. 100 mg) single dose
- Adult: 200 mg (300 mg in cholera) single dose
Plague
- Child under 45 kg: 4.4 mg/kg (max. 200 mg) on D1 then 2.2 mg/kg (max. 100 mg) 2 times daily
- Child 45 kg and over and adult: 200 mg on D1 then 100 mg 2 times daily
Other indications
- Child under 45 kg: 2 to 2.2 mg/kg (max. 100 mg) 2 times daily
- Child 45 kg and over and adult: 100 mg 2 times daily
- In severe infections, a loading dose (as for plague) is recommended.
Duration
- Rickettsiosis: 5 to 7 days or until 3 days after fever has disappeared
- Leptospirosis, cervicitis and urethritis due to C. trachomatis: 7 days
- Cutaneous anthrax, tick-borne relapsing fever: 7 to 10 days
- Plague, atypical pneumonia: 10 to 14 days
- Early syphilis, bejel, pinta, lymphogranuloma: 14 days
- Filariasis: minimum 4 weeks
- Late latent syphilis: 30 days
- Brucellosis: 6 weeks
- Donovanosis: until complete healing of lesions
Contra-indications, adverse effects, precautions
- Do not administer to patients with allergy to cyclines.
- Do not administer treatments longer than 21 days in children under 8 years (risk of discolouration of teeth).
- Administer with caution to patients with hepatic or renal impairment.
- May cause: gastrointestinal disturbances, allergic reactions, photosensitivity (protect exposed skin from sun exposure), oesophageal ulcerations (take tablets during meals with a glass of water in an upright position and at least 1 hour before going to bed).
- Do not give simultaneously with ferrous salts, zinc sulfate, calcium carbonate, antiacids (aluminium/magnesium hydroxide, etc.): administer 2 hours apart.
- Monitor combination with hepatic enzyme inducers: rifampicin, phenobarbital, phenytoin, carbamazepine, etc. (reduction of the doxycycline efficacy).
- Pregnancy: avoid during the 2nd and 3rd trimester (risk of discolouration and malformation of teeth). Use only for severe infections when doxycycline is the most effective option, and the benefits outweigh the risks. No contra-indication for single dose treatments.
- Breast-feeding: avoid if possible (risk of infant teeth discolouration) or do not exceed 10 days of treatment if there is no alternative.
Remarks
- Doxycycline is also used:
- as an alternative to first-line treatment for septicaemia of pulmonary origin (dose as for plague), in combination with other antibacterials;
- for prophylaxis of plague, scrub typhus and leptospirosis.