Doxycycline, capsules
The drug is taken orally during or after meals with a glass of water. Capsules are taken while sitting or standing and well before bedtime to reduce the risk of irritation and ulceration of the esophagus. If signs of stomach irritation are observed, it is recommended that you take doxycycline with food or milk. The usual dose for the treatment of acute infections for adults and children over 12 years of age weighing more than 45 kg is on the first day 200 mg (2 capsules) in 1 or 2 doses, from the second day - 100 mg (1 capsule) 1 time per day. The maximum daily dose for severe infections is 200 mg/day in 1–2 doses (especially for chronic urinary tract infections).
The duration of treatment depends on the type of infection and is usually 5–10 days. For Lyme disease, the course of treatment is 3–4 weeks, for brucellosis – 1.5–6 months. Therapy should be continued for at least 24–48 hours after symptoms have resolved. In the case of streptococcal infection, the duration of therapy should be at least 10 days to prevent rheumatism or glomerulonephritis. Uncomplicated gonococcal infection in adults (except anorectal infection in men): 100 mg 2 times a day for 7 days. As an alternative: an initial dose of 300 mg, then an hour later a repeat dose of 300 mg.
Uncomplicated urethritis, endocervicitis, or rectal infection in adults caused by C. trachomatis: 100 mg twice daily for 7 days.
Non-gonococcal urethritis caused by C. trachomatis or U. urealyticum: 100 mg 2 times a day for 7 days. Early syphilis: 100 mg 2 times a day for 2 weeks (for non-pregnant patients with an allergy to penicillin).
Syphilis of more than one year's duration: 100 mg twice daily for 4 weeks (for non-pregnant patients allergic to penicillin). Acute epididymo-orchitis caused by N. gonorrhoeae or C. trachomatis: 100 mg 2 times daily for at least 10 days.
For the treatment of acne - 50 mg/day for 6–12 weeks.
Treatment of malaria caused by chloroquine-resistant P. falciparum: 200 mg/day for at least 7 days. Given the potential severity of the infection, a fast-acting schizonticidal drug such as quinine should be used concomitantly with doxycycline, the recommended dosage of which varies by region.
Prevention of malaria: 100 mg/day in adults; in children over 12 years of age, the drug is prescribed at a dose of 2 mg/kg 1 time per day; the dose can reach that for adults. Prophylaxis can be prescribed 1–2 days before travel to an area where malaria occurs. This should be continued throughout the trip and for 4 weeks after returning.
Prevention of Japanese river fever: 200 mg once orally. Prevention of travelers' diarrhea in adults: 200 mg on the first day of travel (once or 100 mg every 12 hours), and then 100 mg/day throughout your stay in the region. There is no information on the prophylactic use of the drug for more than 21 days.
Prevention of leptospirosis: 200 mg orally once a week throughout your stay in the region and 200 mg at the end of the trip. There is no information on the prophylactic use of the drug for more than 21 days. Pulmonary anthrax (after exposure): adults, 100 mg orally 2 times a day for 60 days. Children weighing less than 45 kg: 2.2 mg/kg orally 2 times a day for 60 days. In children weighing more than 45 kg, doxycycline is used at the usual dose for adults.
For tick-borne and louse-borne relapsing fever, doxycycline was successfully used in a single dose of 100 mg or 200 mg, depending on the severity of the infection. In order to reduce the risk of persistence or recurrence of tick-borne relapsing fever, it is recommended to use doxycycline 100 mg every 12 hours for 7 days.
Elderly patients: no dose adjustment is required.
Hepatic impairment: Doxycycline should be used with caution in patients with hepatic impairment or in individuals receiving potentially hepatotoxic drugs. Renal Impairment: Studies have shown that the use of doxycycline at usual recommended doses does not result in excessive accumulation of the antibiotic in patients with renal impairment.
In the presence of renal failure, no dose adjustment is required.
Doxycycline
Doxycycline
(eng.
doxycycline
) is a semi-synthetic antibiotic of wide use, a derivative of tetracycline. In gastroenterology, it is considered as a drug that can cause inflammation of the mucous membrane of the upper gastrointestinal tract and thus provoke the development of esophagitis, ulcers of the esophagus, stomach and duodenum.
Doxycycline is a chemical
Chemically, doxycycline is [4S-(4alpha,4a alpha,5alpha,5a alpha,6alpha,12a alpha)]-4-(Dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3 ,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-2-naphthacenecarboxamide. The empirical formula for doxycycline is C22H24N2O8. The molecular weight of doxycycline is 444.435 g/mol. Doxycycline, as a chemical, appears as a light yellow crystalline powder.
Doxycycline - medicine
Doxycycline is the international nonproprietary name (INN) of the drug. According to the pharmacological index, doxycycline belongs to the “Tetracyclines” group. According to ATC, doxycycline is included (or was previously included) in a number of groups and is assigned different codes, in particular:
- "A01 Dental preparations", code A01AB22
- "J01 Antibacterial drugs for systemic use", code J01AA02
In medications, doxycycline is used in the form of hydrochloride, monohydrate or hyclate.
Microorganisms against which doxycycline is or is not active
Doxycycline is active against:
- gram-negative bacteria: Neisseria gonorrhoeae, Calymmatobacterium granulomatis, Haemophilus ducreyi, Haemophilus influenzae, Yersinia pestis, Francisella tularensis, Vibrio cholerae, Bartonella bacilliformis, Brucella specie, Campylobacter fetus
- and also: Escherichia coli, Klebsiella spp., Shigella spp., Acinetobacter spp., Bacteroides spp., Helicobacter pylori
; taking into account that many strains of these groups of bacteria are resistant to tetracyclines, therefore, before using doxycycline, testing its effectiveness is required
,
Propionibacterium acnes,
alpha-hemolytic streptococci
.
Pseudomonas aeruginosa, Proteus spp., Serratia spp.
are resistant to doxycycline , most strains of
Bacteroides fragilis
.
Indications for the use of doxycycline
Doxycycline is indicated for infections caused by microorganisms sensitive to it:
- respiratory tract infections caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci.
For infections of the respiratory tract and ENT organs caused by
Haemophilus influenzae, Klebsiella spp., Streptococcus pneumoniae,
doxycycline is used as an alternative drug in patients with hypersensitivity to penicillin; - infections of the genitourinary system caused by Chlamydia trachomatis, Ureоplasma urealitycum
- conjunctivitis caused by Chlamydia trachomatis
- typhus, ehrlichiosis, Rocky Mountain fever, Q fever, trench fever and other infections caused by Rickettsia spp.
- sexually transmitted infections in patients with hypersensitivity to penicillins: gonorrhea - caused by Neisseria gonorrhoeae
and syphilis - caused by
Treponema pallidum,
chancroid - caused by
Haemophilus ducreуi - cholera is caused by Vibrio comma
- early stages of Lyme disease with skin manifestations (erythema migrans annulare, benign cutaneous lymphoma)
- inguinal granuloma caused by Calymmatobacterium granulomatis
- trachoma—causative agent Chlamydia trachomatis
- psittacosis - causative agent Chlamydia psittaci
- Brucellosis is caused by Brucella spp
. in combination with streptomycin; - bortonellosis caused by Bartonella bacilliformis
- plague - causative agent Yersinia pestis
- tularemia caused by Francisella tularensis
- infections caused by Campylobacter fetus
- prevention of malaria caused by Plasmodium falciparum
during a stay of up to four months in an area where Plasmodium resistance to chloroquine and/or pyrimethamine-sulfadoxine has been noted
The role of doxycycline in the development of gastroesophageal reflux disease
If there is inflammation of the esophageal mucosa, it is necessary to limit the intake of doxycycline. Different authors emphasize different ways in which doxycycline may have a negative effect on the esophagus:
- doxycycline can reduce the tone of the lower esophageal sphincter (Maev I.V. et al., Sayfutdinov R.G., Trifonova E.V.)
- doxycycline can irritate or directly damage the mucous membrane of the esophagus (Bueverov A.O., Rapoport S.I. et al., Masharova A.A., Kim V.A.)
Taking doxycycline is one of the most common causes of drug-induced damage to the esophagus and the development of esophagitis in young patients (Tkach S.M., Kuzenko Yu.G.).
To prevent irritation to the mucous membrane of the esophagus and stomach, it is recommended to take doxycycline during the day with plenty of liquid, food or milk.
Doxycycline and gastric and duodenal ulcers
Doxycycline has been used to treat gastric and duodenal ulcers associated with Helicobacter pylori
since the 1990s.
In particular, it was recommended as part of a four-component regimen for the second line
of eradication of
Helicobacter pyrori
: doxycycline 200 mg 2 times a day + proton pump inhibitor in a standard dose + tripotassium bismuth dicitrate 120 mg 4 times a day + furazolidone 100 mg 4 times a day for 7 days.
Recently, in different countries, Helicobacter pyrori
to doxycycline has reached 33.3% and continues to increase annually (Y. S. Zimmerman).
In the work of Nizhevich A.A. eradication of Helicobacter pyrori
in children, when using the regimen doxycycline (200 mg/day) + omeprazole (1 mg/kg/day) + bismuth tripotassium dicitrate (8 mg/kg/day) + furazolidone (20 mg/kg/day) reaches 86.7%.
Maastricht IV does not recommend the use of doxycycline instead of tetracycline hydrochloride in Helicobacter pyrori
(Isakov V.A.).
Currently, doxycycline is considered as one of the ulcerogenic drugs that can cause the formation of gastroduodenal ulcers. Patients taking ulcerogenic drugs are at very high risk of developing gastrointestinal bleeding. Doctors should be wary of the possibility of complications during treatment with ulcerogenic drugs and instruct patients about the rules for taking them and contraindications to them (Agapova N.G.). To reduce the ulcerogenic effect, it is recommended to take doxycycline during the day with plenty of liquid or food.
Side effects of doxycycline
In addition to the above effects on the upper gastrointestinal mucosa, doxycycline can cause vomiting, nausea, abdominal pain, constipation, diarrhea, anorexia, headache, papilledema, vision changes, dizziness, hemolytic anemia, thrombocytopenia, eosinophilia , neutropenia, decreased prothrombin activity.
Professional medical publications addressing the use of doxycycline in gastroenterology
- Agapova N.G. About drug-induced gastroduodenal ulcers // Journal “Mystery of Likuvannya”. Ukraine. – 2007. – 2(38).
- Nizhevich A.A. Clinical and morphological characteristics, genetic markers, diagnosis and treatment of HP-associated gastroduodenal diseases in children. Abstract of dissertation. Doctor of Medical Sciences, 01/14/08 - pediatrics, 01/14/28 - gastroenterology. BSMU, Moscow, 2010
- Pfizer Labs instructions for the USA (in English, pdf): Vibramycin Calcium (doxycycline calcium oral suspension, USP), oral suspension, Syrup. Vibramycin Hyclate (doxycycline hyclate capsules, USP), Capsules. Vibramycin Monohydrate (doxycycline monohydrate) for oral suspension. Vibra-Tabs (doxycycline hyclate tablets, USP), film coated tablets.
On the website in the literature catalog there is a section “NSAIDs and other drug-induced gastropathy”, containing articles on gastrointestinal diseases caused by the use of various drugs.
Use of doxycycline during pregnancy, breastfeeding and children
Dixocycline is contraindicated during pregnancy and breastfeeding.
Dixocycline penetrates the placental barrier. The FDA Fetal Action Category for dixocycline is D (there is evidence of a risk of adverse effects of the drug on the human fetus, but the potential benefit associated with the use of the drug in pregnant women may justify its use despite the risk).
Doxycycline is not used in children under 8 years of age, as it causes long-term discoloration of teeth, enamel hypoplasia, and slower longitudinal growth of skeletal bones.
Trade names of drugs containing the active ingredient doxycycline
The following drugs with the only active ingredient doxycycline are registered (were previously registered) in Russia: Bassado, Vibramycin, Vidoccin, Dovicin, Doxal, Doxibene, Doxibene M, Doxylan, Doxycycline, Doxycycline Nycomed, Doxycycline Stada, Doxycycline-AKOS, Doxycycline-Ferein, Doxycycline hydrochloride, Doxycycline hydrochloride capsules, Xedocin, Monoclin, Unidox Solutab.
Brands of doxycycline in the USA are Adoxa, Alodox, Avidoxy, Doryx, Monodox, Morgidox, Ocudox, Oracea, Oraxyl, Vibramycin.
general information
Doxycycline is a prescription drug in both Russia and the USA.
Doxycycline has contraindications, side effects and application features; consultation with a specialist is necessary.
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Doxycycline
Intravenous administration (IV) of Doxycycline is preferable in severe forms of purulent-septic diseases, when it is necessary to quickly create a high concentration of the drug in the blood and tissues, as well as in cases where oral administration of the drug is difficult. Step therapy is recommended, that is, switching to oral doxycycline dosage forms as soon as possible.
For adults
The usual daily dose of Doxycycline is 200 mg/day, administered once a day, or 100 mg every 12 hours.
The duration of therapy is determined by the form and severity of the infection; administered intravenously for 3-5 days, if necessary and/or well tolerated, parenteral administration is extended to 7 days; subsequently (according to indications!) switch to taking Doxycycline orally.
For pelvic inflammatory diseases in women in the acute stage of the disease
administered intravenously at 100 mg every 12 hours; Combination therapy with third generation cephalosporins is recommended. If the response to therapy is positive and the patient’s condition is stabilized, therapy is continued with dosage forms of doxycycline for oral administration, 100 mg 2 times a day for 14 days.
For the treatment of syphilis (primary or secondary)
the dose of Doxycycline is 300 mg/day; treatment is continued for at least 10 days (according to indications, during the process it is possible to replace intravenous administration with oral administration of the drug).
Considering the pharmacokinetics and preferential excretion of doxycycline through the intestines with bile, in patients with impaired renal function
is administered in normal therapeutic doses, no dose adjustment is required.
In children over 8 years old
doses are calculated based on body weight, the recommended daily dose on the first day of therapy is 4 mg/kg in 1 or 2 administrations, then 2-4 mg/kg per day in 1 or 2 administrations, depending on the severity of the infection.
In children weighing more than 45 kg, doses indicated for adults are used.
RULES FOR PREPARATION OF SOLUTIONS
Preparation of Doxycycline solution for intravenous infusion is carried out in two stages:
Stage 1 - the contents of the bottle (ampoule) with 100 mg or 200 mg of sterile lyophilisate are diluted with 10 ml of sterile water for injection or 0.9% sodium chloride solution.
Stage 2 - the Doxycycline solution obtained during the initial dilution is added to 250 or 500 ml of one of the following infusion media: 0.9% sodium chloride solution or 5% dextrose (glucose) solution. The recommended concentration range of the prepared solution for infusion is from 0.1 mg/ml to 1 mg/ml.
The duration of infusion, depending on the dose (0.1 or 0.2 g) and the volume of the finished solution, is about 1-4 hours at an injection rate of 60-80 drops/min. The recommended duration of infusion of a solution containing 100 mg of doxycycline at a concentration of 0.5 mg/ml is 60 minutes.
