Infectious Disease Compendium

Doxycycline (Vibramycin ®)

Dosing

CrCl Formula

CrCl > 80: 100 po/iv q 12 h.

CrCl 80-50:

CrCl 50-10:

CrCl < 10:

Hemodialysis:

Peritoneal dialysis:

Important side effects

Deposits in bone and teeth, photosensitivity.

Important drug interactions

Acitretin, aluminum, calcium or magnesium containing products, bismuth subsalicylate, carbamazepine, cisatracurium, dicumarol, ethinyl estradiol, fosphenytoin, iron, isotretinoin, mestranol, methotrexate, norelgestromin, norethindrone, norgestrel, phenobarbital, phenytoin, rapacuronium, rifampin, rifapentine, warfarin.

Rants and Screeds

From July 15, CID

"Not long ago, the cost to the pharmacy at that hospital had suddenly risen from $10 for fifty 100-mg doxycycline pills to a stag- gering $250 for 50 pills. I cannot trace the reason for this unbelievable jump in price, but occurrences like this have to be part of the problem with the cost of medical care in the United States. Doxycycline is an old generic drug that is the oral drug of choice for Lyme disease as well as other indications; it has been cheap up to now. Someone is taking advantage of the population requiring this drug."

Now that the cost has increased up 2000%, for many infections can use minocycline instead (Minocycline as A Substitute for Doxycycline in Targeted Scenarios: A Systematic Review).  And as a result they will probably jack up the price of minocycline as well.

Pearls

Treatment of choice

Use for

Anthrax (post-exposure prophylaxis, gi,pulmonary and cutaneous), bacillary angiomatosis, Acinetobacter infections, acne, actinomycosis, amebiasis, Bartonella, bronchitis, Brucella, Calymmatobacterium granulomatis, Campylobacter fetus infections, chancroid, Chlamydia infections, cholera, Clostridium infections, colonic surgery prophylaxis, pneumonia-community-acquired, conjunctivitis, COPD exacerbation, donovanosis, Ehrlichia chaffeensis infections, Enterobacter infections, Epididymitis, Escherichia coli, Gonorrhea, granuloma inguinale, hysterectomy, Leptospira, Listeria monocytogenes, Lyme disease, Lymphogranuloma venereum, Malaria, malignant pleural effusions, Mediterranean Spotted Fever, Meliodosis, Mycobacterium infections, Mycoplasm pneumoniae infections, nongonococcal urethritis, onchocerciasis, Psittacosis, PID, periodontal disease, periodontitis, plague, pneumonia, postabortal infection prophylaxis, pre-menstrual syndrome, Proctitis, Q fever,Relapsing Fever, Rickettsia conorii, Rocky Mountain Spotted Fever, rosacea, sclerotherapy, scrub typhus Rickettsia, sexual assault, Shigella, Sweets syndrome, Syphilis, Toxoplasma, travelers' diarrhe, tularemia, typhus, urethritis, UTI, Vibrio cholerae, Vibrio vulnificus, Vincent's infection, yaws, Yersinia pestis.

Don't use for

Class

Tetracycline.