doxycycline (Vibramycin, Doryx, Periostat, Oracea)
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Introduction
Tradenames: Vibramycin, Doryx.
Indications
- bacterial infections caused by susceptible bacteria, including mycoplasma & chlamydia, spirochetes, rickettsiae & some protozoa
- tularemia, brucellosis, listeriosis, actinomycosis, psittacosis, trachoma[11]
- rickettsial infection
- other tick borne-infection
- anthrax, cutaneous anthrax, inhalation anthrax[11]
- upper respiratory tract infecton
- lower respiratory tract infection
- oral cavity infection
- gastrointestinal infection
- urogenital infection
- syphilis, uncomplicated gonorrhea orchitis, chanchroid, lymphogranuloma venereum, donovanosis, yaws
- treatment of non gonococcal urethritis caused by Chlamydia trachomatis & Ureaplasma urealyticum
- skin or soft tissue infection
- mycobacterial infection[11]
- anoplura (lice)
- malaria
- leptosopirosis
- eye infection
- prevention of "Traveler's Diarrhea" caused by E. coli
- prevention of plague[11]
- pleural effusion: used as a sclerosing agent in pleurodesis
- investigational use as disease-modifying antirheumatic agent
- investigational use in osteoarthritis[9]
Contraindications
- not for use by children < 12 years of age
- pregnancy category: D
Dosage
Tabs: 50, 100 mg
Syrup: 25 & 50 mg/5 mL
Periostat: (doxycycline hyclate): 20 mg PO BID
Oracea: 40 mg/day (anti-inflammatory, but NOT antibacterial)[10]
Pharmacokinetics
- well distributed to most tissues, including CSF
- protein-binding 90%
- not metabolized, partially inactivated in GI tract
- elimination
- 1/2life is 16 hours with normal renal function
- slightly prolonged with severe renal insufficiency
- 23-41% excreted unchanged into the urine,
- 30-59% excreted unchanged in the feces
- no dose adjustment necessary with renal failure
elimination via liver
elimination via kidney
protein binding = 90 %
Antimicrobial activity
- Streptococcus
- Streptococcus group A (+/-)
- Streptococcus group B (+/-)
- Streptococcus group C (+/-)
- Streptococcus group G (+/-)
- Streptococcus pneumonia
- Staphylococcus aureus (MSSA) (+/-)
- Staphylococcus aureus (MRSA) (+/-)
- Enterococcus (Vancomycin-resistant, some)
- Neisseria gonorrhoeae (+/-)
- Moraxella catarrhalis
- Haemophilus influenzae
- Aeromonas
- Escherichia coli (+/-)
- Yersinia enterocolitica
- Francisella tularensis
- Brucella species
- Vibrio vulnificus
Adverse effects
- nausea/vomiting
- erosive pill esophagitis (1-10%)
- phototoxicity, dose-related (less than with tetracycline)
- tooth deposition (less than with tetracycline)
- phlebitis with frequent IV administration
- dyspepsia, abdominal cramps
- loss of appetite
- neutropenia
- eosinophilia
- hepatotoxicity
- rash
- diarrhea
- vaginal yeast infection
- 2-fold increased risk of miscarriage[13]
- increased intracranial pressure (pseudotumor cerebri)[12]
Drug interactions
(see tetracycline)
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Mechanism of action
- bacteriostatic
- inhibits bacterial protein synthesis
- inhibits collagenase[9]
More general terms
Additional terms
- gonorrhea
- pleurodesis; chemical pleurodesis
- Rickettsia
- Spirochaetaceae
- traveler's diarrhea
- urethritis
Component of
References
- ↑ Geriatric Dosage Handbook, 6th edition, Selma et al eds, Lexi-Comp, Cleveland, 2001
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 164
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Prescriber's Letter 6(10):58, Oct, 1999
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, Update 9/99
- ↑ Physician's Desk Reference (PDR) 56th edition, Medical Economics, 2002
- ↑ 9.0 9.1 9.2 Prescriber's Letter 12(9): 2005 Doxycycline for Osteoarthritis Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211014&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 10.0 10.1 Prescriber's Letter 13(7): 2006 New Formulations of Tetracyclines (Solodyn and Oracea) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220709&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Deprecated Reference
- ↑ 12.0 12.1 12.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 19 American College of Physicians, Philadelphia 2015, 2021
- ↑ 13.0 13.1 Muanda FT, Sheehy O, Berard A Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017 May 1;189:E625-33 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28461374 <Internet> http://www.cmaj.ca/content/189/17/E625.full.pdf+html
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=11256
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5282374
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5282244
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5281011
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=494135
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3161
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=365702
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3033826