Drugs List

Therapeutic Indications

Uses

Acne vulgaris
Antibiotic sensitive infections
Malaria - prophylaxis
Prophylaxis of leptospirosis
Prophylaxis of scrub typhus
Prophylaxis of travellers' diarrhoea(enterotoxigenic E. coli)
Treatment of chloroquine resistant malaria
Treatment of louse and tick-borne fevers (Rickettsia, Babesia, Borrelia)
Treatment of sexually transmitted infections

Treatment of infections caused by susceptible strains of Gram-positive and Gram-negative bacteria and certain other micro-organisms.

Types of infections include:
Respiratory tract infections
Chronic bronchitis, sinusitis, pneumonia and other lower respiratory tract infections due to susceptible strains of Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and other organisms including Mycobacteria pneumoniae.

Urinary tract infections
Due to susceptible strains of Klebsiella species, Enterobacter species, Escherichia coli, Streptococcus faecalis and other organisms.

Sexually transmitted infections
Due to Chlamydia trachomatis including uncomplicated urethral, endocervical or rectal infections. Non-gonococcal urethritis caused by Ureaplasma urealyticum (T-mycoplasma). Chancroid granuloma inguinale and lymphogranuloma venereum and as an alternative drug in the treatment of gonorrhoea and syphilis.

Skin infections
Acne vulgaris when antibiotic therapy is considered necessary.

Ophthalmic infections
Due to susceptible strains of gonococci, staphylococci and Haemophilus influenzae. Trachoma (although the infectious agent is not always eliminated). Inclusion conjunctivitis.

Rickettsial infections
Rocky mountain spotted fever, typhus, Q fever, Coxiella endocarditis and tick fevers.

Other infections
Psittacosis, brucellosis (in combination with streptomycin), cholera, bubonic plague, louse and tick-borne relapsing fever, tularaemia, glanders, melioidosis, chloroquine-resistant falciparum malaria, acute amoebiasis (as an adjunct to amoebicides), leptospirosis, gas gangrene and tetanus. Other infections due to susceptible strains of Yersina or Clostridium.

Prophylaxis against the following infections:
Scrub typhus, travellers' diarrhoea, leptospirosis and malaria.

For up to date advice on geographical resistance patterns and appropriate prophylaxis, current guidelines should be consulted.
Guidelines for Malaria Prevention from the Public Health England specifically developed for travellers from the United Kingdom may be obtained on the HPA website: https://www.gov.uk/government/organisations/public-health-england

Unlicensed Uses

Lyme disease
Treatment and prophylaxis of anthrax
Treatment of rosacea

Contraindications

Children under 12 years
Second trimester of pregnancy
Third trimester of pregnancy

Precautions and Warnings

Alcoholism
Breastfeeding
First trimester of pregnancy
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Lactose intolerance
Myasthenia gravis
Systemic lupus erythematosus

Jarisch-Herxheimer reaction possible in treatment of Spirochetes infection
May exacerbate myasthenia gravis
Advise ability to drive/operate machinery may be affected by side effects
Consult national/regional policy on the use of anti-infectives
Drugs for malaria prophylaxis are not prescribable on the NHS
Some formulations contain lactose
Some formulations contain sucrose
Swallow dose with plenty of fluid while sitting or standing
If visual disturbances occur, perform ophthalmic evaluation
Consider C. difficile if diarrhoea occurs within 2 months of treatment
Consider pseudomembranous colitis if patient presents with diarrhoea
Discontinue treatment if DRESS is suspected
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue at first signs of skin erythema
Discontinue if overgrowth of resistant organisms occurs
Discontinue if photosensitivity occurs
Discontinue if signs of raised intracranial pressure
Advise patient not to take St John's wort concurrently
Advise to avoid antacids/mineral supplements 2 hours before or after dose
Advise patient to avoid alcohol during treatment
Advise patient that photosensitivity possible
Avoid excessive exposure to sunlight
Avoid excessive exposure to UV light

Oesophagitis and oesophageal ulceration have been reported in patients receiving doxycycline. The incidence of these effects can be minimised by taking the dose well before retiring to bed, while sitting or standing and with an adequate amount of fluid.

When treating venereal disease, where syphilis is also suspected, appropriate diagnostic procedures (including dark-field examinations) should be conducted. In these cases, monthly serological tests should be made for at least four months.

Pregnancy and Lactation

Pregnancy

Doxycycline is contraindicated in the second and third trimesters of pregnancy.

The manufacturer contraindicates use in pregnancy.

Tetracyclines cross the placenta and bind strongly to calcium ions effecting teeth and skeletal development in the foetus during the second and third trimesters.

High doses in the second half of pregnancy have been associated with severe maternal hepatic toxicity.

In the first trimester tetracyclines are considered to be second line therapy. In such cases doxycycline is the prefered agent. Inadvertent exposure to tetracyclines even after the fifteenth week is not an indication for termination of pregnancy or for invasive diagnostic procedures (Schaefer 2015).

Lactation

Although contraindicated by the manufacturer there is evidence of safety in short term use.

Doxycyline is excreted into breast milk. However, studies on the closely related antibiotic tetracycline have shown undetectable serum levels in the infant.

Avoid prolonged use or repeated courses during breastfeeding and monitor infant for rash and gastrointestinal effects.

Side Effects

Abdominal pain
Abnormal liver function tests
Anaphylactic shock
Anaphylactoid purpura
Anaphylactoid reaction
Anaphylaxis
Angioedema
Anorexia
Anxiety
Arthralgia
Benign intracranial hypertension
Black tongue
Blood urea increased
Blurred vision
Brown-black microscopic discolouration of thyroid tissue
Bulging fontanelles in infants
Candidiasis
Decreased appetite
Diarrhoea
Diplopia
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dyspepsia
Dysphagia
Dyspnoea
Enamel hypoplasia
Eosinophilia
Erythema
Erythema multiforme
Exacerbation of systemic lupus erythematosus
Exfoliative dermatitis
Flushing
Glossitis
Haemolytic anaemia
Headache
Hepatic failure
Hepatitis
Hepatotoxicity
Hypersensitivity reactions
Hypotension
Jarisch-Herxheimer reaction
Jaundice
Loss of vision
Maculopapular rash
Myalgia
Nausea
Neutropenia
Oesophageal ulceration
Oesophagitis
Onycholysis
Pancreatitis
Pericarditis
Peripheral oedema
Photosensitivity
Porphyria
Pseudomembranous colitis
Rash
Scotomata
Serum sickness
Staphylococcal enteritis
Stevens-Johnson syndrome
Stomatitis
Tachycardia
Thrombocytopenia
Tinnitus
Toxic epidermal necrolysis
Urticaria
Vaginitis
Vomiting
Vulvovaginal infections
Yellowish-brown discolouration of teeth

Presentation

Oral formulations of doxycycline (as doxycycline hyclate).

Drugs List

Therapeutic Indications

Uses

Acne vulgaris
Antibiotic sensitive infections
Malaria - prophylaxis
Prophylaxis of leptospirosis
Prophylaxis of scrub typhus
Prophylaxis of travellers' diarrhoea(enterotoxigenic E. coli)
Treatment of chloroquine resistant malaria
Treatment of louse and tick-borne fevers (Rickettsia, Babesia, Borrelia)
Treatment of sexually transmitted infections

Treatment of infections caused by susceptible strains of Gram-positive and Gram-negative bacteria and certain other micro-organisms.

Types of infections include:
Respiratory tract infections
Chronic bronchitis, sinusitis, pneumonia and other lower respiratory tract infections due to susceptible strains of Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and other organisms including Mycobacteria pneumoniae.

Urinary tract infections
Due to susceptible strains of Klebsiella species, Enterobacter species, Escherichia coli, Streptococcus faecalis and other organisms.

Sexually transmitted infections
Due to Chlamydia trachomatis including uncomplicated urethral, endocervical or rectal infections. Non-gonococcal urethritis caused by Ureaplasma urealyticum (T-mycoplasma). Chancroid granuloma inguinale and lymphogranuloma venereum and as an alternative drug in the treatment of gonorrhoea and syphilis.

Skin infections
Acne vulgaris when antibiotic therapy is considered necessary.

Ophthalmic infections
Due to susceptible strains of gonococci, staphylococci and Haemophilus influenzae. Trachoma (although the infectious agent is not always eliminated). Inclusion conjunctivitis.

Rickettsial infections
Rocky mountain spotted fever, typhus, Q fever, Coxiella endocarditis and tick fevers.

Other infections
Psittacosis, brucellosis (in combination with streptomycin), cholera, bubonic plague, louse and tick-borne relapsing fever, tularaemia, glanders, melioidosis, chloroquine-resistant falciparum malaria, acute amoebiasis (as an adjunct to amoebicides), leptospirosis, gas gangrene and tetanus. Other infections due to susceptible strains of Yersina or Clostridium.

Prophylaxis against the following infections:
Scrub typhus, travellers' diarrhoea, leptospirosis and malaria.

For up to date advice on geographical resistance patterns and appropriate prophylaxis, current guidelines should be consulted.
Guidelines for Malaria Prevention from the Public Health England specifically developed for travellers from the United Kingdom may be obtained on the HPA website: https://www.gov.uk/government/organisations/public-health-england

Unlicensed Uses

Lyme disease
Treatment and prophylaxis of anthrax
Treatment of rosacea

Dosage

Adults

Children

Contraindications

Children under 12 years
Second trimester of pregnancy
Third trimester of pregnancy

Precautions and Warnings

Alcoholism
Breastfeeding
First trimester of pregnancy
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Lactose intolerance
Myasthenia gravis
Systemic lupus erythematosus

Jarisch-Herxheimer reaction possible in treatment of Spirochetes infection
May exacerbate myasthenia gravis
Advise ability to drive/operate machinery may be affected by side effects
Consult national/regional policy on the use of anti-infectives
Drugs for malaria prophylaxis are not prescribable on the NHS
Some formulations contain lactose
Some formulations contain sucrose
Swallow dose with plenty of fluid while sitting or standing
If visual disturbances occur, perform ophthalmic evaluation
Consider C. difficile if diarrhoea occurs within 2 months of treatment
Consider pseudomembranous colitis if patient presents with diarrhoea
Discontinue treatment if DRESS is suspected
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue at first signs of skin erythema
Discontinue if overgrowth of resistant organisms occurs
Discontinue if photosensitivity occurs
Discontinue if signs of raised intracranial pressure
Advise patient not to take St John's wort concurrently
Advise to avoid antacids/mineral supplements 2 hours before or after dose
Advise patient to avoid alcohol during treatment
Advise patient that photosensitivity possible
Avoid excessive exposure to sunlight
Avoid excessive exposure to UV light

Oesophagitis and oesophageal ulceration have been reported in patients receiving doxycycline. The incidence of these effects can be minimised by taking the dose well before retiring to bed, while sitting or standing and with an adequate amount of fluid.

When treating venereal disease, where syphilis is also suspected, appropriate diagnostic procedures (including dark-field examinations) should be conducted. In these cases, monthly serological tests should be made for at least four months.

Pregnancy and Lactation

Pregnancy

Doxycycline is contraindicated in the second and third trimesters of pregnancy.

The manufacturer contraindicates use in pregnancy.

Tetracyclines cross the placenta and bind strongly to calcium ions effecting teeth and skeletal development in the foetus during the second and third trimesters.

High doses in the second half of pregnancy have been associated with severe maternal hepatic toxicity.

In the first trimester tetracyclines are considered to be second line therapy. In such cases doxycycline is the prefered agent. Inadvertent exposure to tetracyclines even after the fifteenth week is not an indication for termination of pregnancy or for invasive diagnostic procedures (Schaefer 2015).

Lactation

Although contraindicated by the manufacturer there is evidence of safety in short term use.

Doxycyline is excreted into breast milk. However, studies on the closely related antibiotic tetracycline have shown undetectable serum levels in the infant.

Avoid prolonged use or repeated courses during breastfeeding and monitor infant for rash and gastrointestinal effects.

Side Effects

Abdominal pain
Abnormal liver function tests
Anaphylactic shock
Anaphylactoid purpura
Anaphylactoid reaction
Anaphylaxis
Angioedema
Anorexia
Anxiety
Arthralgia
Benign intracranial hypertension
Black tongue
Blood urea increased
Blurred vision
Brown-black microscopic discolouration of thyroid tissue
Bulging fontanelles in infants
Candidiasis
Decreased appetite
Diarrhoea
Diplopia
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dyspepsia
Dysphagia
Dyspnoea
Enamel hypoplasia
Eosinophilia
Erythema
Erythema multiforme
Exacerbation of systemic lupus erythematosus
Exfoliative dermatitis
Flushing
Glossitis
Haemolytic anaemia
Headache
Hepatic failure
Hepatitis
Hepatotoxicity
Hypersensitivity reactions
Hypotension
Jarisch-Herxheimer reaction
Jaundice
Loss of vision
Maculopapular rash
Myalgia
Nausea
Neutropenia
Oesophageal ulceration
Oesophagitis
Onycholysis
Pancreatitis
Pericarditis
Peripheral oedema
Photosensitivity
Porphyria
Pseudomembranous colitis
Rash
Scotomata
Serum sickness
Staphylococcal enteritis
Stevens-Johnson syndrome
Stomatitis
Tachycardia
Thrombocytopenia
Tinnitus
Toxic epidermal necrolysis
Urticaria
Vaginitis
Vomiting
Vulvovaginal infections
Yellowish-brown discolouration of teeth

Effects on Laboratory Tests

False elevations of urinary catecholamines may occur due to interference with the fluorescence test.

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2019

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Products Characteristics: Doxycycline 50mg Capsules. Kent Pharmaceuticals. Revised September 2018.
Summary of Products Characteristics: Doxycycline and Vibrox 100mg Capsules. Kent Pharmaceuticals. Revised December 2018.

Summary of Products Characteristics: Doxycycline 50mg Capsules. Accord. Revised August 2018.
Summary of Products Characteristics: Doxycycline 100mg Capsules. Accord. Revised August 2018.

Summary of Products Characteristics: Doxycycline 50mg Capsules. Teva UK Ltd. Revised September 2018.
Summary of Products Characteristics: Doxycycline 100mg Capsules. Teva UK Ltd. Revised September 2018.

Summary of Products Characteristics: Doxycycline 100mg Capsules. Generics UK. Revised June 2018.

The Welsh Medicines Information Centre (WMIC) Porphyria Information Service.
Available at: https://www.wmic.wales.nhs.uk/porphyria_info.php
Last revised: April 2018
Last accessed: 07 March 2019

The Norwegian Porphyria Centre (NAPOS).
Available at: https://www.drugs-porphyria.org
Last revised: 22 September 2018
Last accessed: 07 March 2019

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 11 March 2019.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Doxycyline Last revised: 31 October 2018
Last accessed: 18 March 2019.