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Medication Safety Issues
Sound-alike/look-alike issues:
Doxycycline may be confused with dicyclomine, doxepin, doxylamine
Doxy-100® may be confused with Doxil®
Monodox® may be confused with Maalox®
Oracea™ may be confused with Orencia®
Pronunciation
(doks i SYE kleen)
U.S. Brand Names
Index Terms
Generic Available
Yes: Excludes capsule (variable release), powder for oral solution, syrup
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use
Principally in the treatment of infections caused by susceptible Rickettsia, Chlamydia, and Mycoplasma; alternative to mefloquine for malaria prophylaxis; treatment for syphilis, uncomplicated Neisseria gonorrhoeae, Listeria, Actinomyces israelii, and Clostridium infections in penicillin-allergic patients; used for community-acquired pneumonia and other common infections due to susceptible organisms; anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure); treatment of infections caused by uncommon susceptible gram-negative and gram-positive organisms including Borrelia recurrentis, Ureaplasma urealyticum, Haemophilus ducreyi, Yersinia pestis, Francisella tularensis, Vibrio cholerae, Campylobacter fetus, Brucella spp, Bartonella bacilliformis, and Calymmatobacterium granulomatis, Q fever, Lyme disease; treatment of inflammatory lesions associated with rosacea
Use: Dental
Treatment of periodontitis associated with presence of Actinobacillus actinomycetemcomitans (AA); Atridox™ is indicated for the treatment of chronic adult periodontitis for gain in clinical attachment, reduction in probing depth, and reduction in bleeding on probing; Periostat® is indicated for use as an adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in adult periodontitis (systemic levels are subinhibitory against bacteria)
Use: Unlabeled/Investigational
Sclerosing agent for pleural effusion injection; vancomycin-resistant enterococci (VRE)
Pregnancy Risk Factor
D
Pregnancy Implications
Because use during pregnancy may cause fetal harm, doxycyline is classified as pregnancy category D. Exposure to tetracyclines during the second or third trimester may cause permanent discoloration of the teeth. Most reports do not show an increase risk for teratogenicity with the exception of a potential small increased risk for cleft palate or esophageal atresia/stenosis. When considering treatment for life-threatening infection and/or prolonged duration of therapy (such as in anthrax), the potential risk to the fetus must be balanced against the severity of the potential illness.
Lactation
Enters breast milk/not recommended
Breast-Feeding Considerations
Tetracyclines, including doxycycline, are excreted in breast milk and therefore, breast-feeding is not recommended by the manufacturer.
Doxycycline is less bound to the calcium in maternal milk which may lead to increased absorption compared to other tetracyclines. Only minimal amounts of doxycycline are excreted in human milk and the relative amount of tooth staining has been reported to be lower when compared to other tetracycline analogs. Nondose-related effects could include modification of bowel flora.
Contraindications
Hypersensitivity to doxycycline, tetracycline or any component of the formulation; children ?8 years of age, except in treatment of anthrax (including inhalational anthrax postexposure prophylaxis); severe hepatic dysfunction; pregnancy
Warnings/Precautions
Concerns related to adverse effects:
• Autoimmune syndromes: Have been reported.
• Hepatotoxicity: Rarely occurs; if symptomatic, conduct LFT and discontinue drug.
• Increased BUN: May be associated with increases in BUN secondary to antianabolic effects; use caution in patients with renal impairment.
• Photosensitivity: May cause photosensitivity; discontinue if skin erythema occurs. Use skin protection and avoid prolonged exposure to sunlight; do not use tanning equipment.
• Pseudotumor cerebri: Has been (rarely) reported with tetracycline use; usually resolves with discontinuation.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Special populations:
• Pediatrics: May cause tissue hyperpigmentation, enamel hypoplasia, or permanent tooth discoloration; use of tetracyclines should be avoided during tooth development (children ?8 years of age) unless other drugs are not likely to be effective or are contraindicated. However, recommended in treatment of anthrax exposure.
• Pregnancy: Do not use during pregnancy. In addition to affecting tooth development, tetracycline use has been associated with retardation of skeletal development and reduced bone growth.
Dosage form specific issues:
• Oracea™: Should not be used for the treatment or prophylaxis of bacterial infections, since the lower dose of drug per capsule may be subefficacious and promote resistance.
• Periostat®: Effectiveness has not been established in patients with coexistent oral candidiasis; use with caution in patients with a history or predisposition to oral candidiasis.
• Syrup: Contains sodium metabisulfite.
Adverse Reactions
Frequency not defined.
Cardiovascular: Intracranial hypertension, pericarditis
Dermatologic: Angioneurotic edema, exfoliative dermatitis (rare), photosensitivity, rash, skin hyperpigmentation, urticaria
Endocrine & metabolic: Brown/black discoloration of thyroid gland (no dysfunction reported), hypoglycemia
Gastrointestinal: Anorexia, diarrhea, dysphagia, enterocolitis, esophagitis (rare), esophageal ulcerations (rare), glossitis, inflammatory lesions in anogenital region, nausea, oral (mucosal) pigmentation, pseudomembranous colitis, tooth discoloration (children), vomiting
Hematologic: Eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia
Hepatic: Hepatotoxicity
Renal: BUN increased (dose related)
Miscellaneous: Anaphylactoid purpura, anaphylaxis, bulging fontanels (infants), serum sickness, SLE exacerbation
Note: Adverse effects in clinical trials with Periostat® occurring at a frequency more than 1% greater than placebo included nausea, dyspepsia, joint pain, diarrhea, menstrual cramp, and pain.
Drug Interactions
Substrate of CYP3A4 (major); Inhibits CYP3A4 (moderate)
Antacids (containing aluminum, calcium, or magnesium): Decreased absorption of tetracyclines
Barbiturates: May decrease the level/effect of doxycycline.
Bile acid sequestrants: May decrease the absorption of tetracycline derivatives.
Bismuth: May decrease the absorption of tetracycline derivatives.
Bismuth subsalicylate: May decrease the absorption of tetracycline derivatives.
Carbamazepine: May decrease the level/effect of doxycycline.
Coumarin derivatives: Tetracycline derivatives may enhance the anticoagulant effect of coumarin derivatives.
CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of doxycycline. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.
CYP3A4 substrates: Doxycycline may increase the levels/effects of CYP3A4 substrates. Example substrates include benzodiazepines, calcium channel blockers, mirtazapine, nateglinide, nefazodone, tacrolimus, and venlafaxine. Selected benzodiazepines (midazolam and triazolam), cisapride, ergot alkaloids, selected HMG-CoA reductase inhibitors (lovastatin and simvastatin), and pimozide are generally contraindicated with strong CYP3A4 inhibitors.
Iron-containing products: Decreased absorption of tetracyclines.
Magnesium salts (oral): May decrease the absorption of tetracycline derivatives (oral).
Methotrexate: Tetracycline derivatives may increase the serum concentration of methotrexate.
Methoxyflurane: Concomitant use may cause fatal renal toxicity. Avoid concurrent use.
Penicillins: Tetracycline derivatives may diminish the therapeutic effect of penicillins.
Phenytoin: May decrease the level/effect of doxycycline.
Pimecrolimus: Doxycycline may decrease the metabolism, via CYP isoenzymes, of pimecrolimus.
Quinapril: May decrease the absorption of tetracycline derivatives.
Retinoic acid derivatives: Tetracycline derivatives may enhance the adverse/toxic effect of retinoic acid derivatives. The development of pseudotumor cerebri is of particular concern.
Typhoid vaccine: Antibiotics may diminish the therapeutic effect of typhoid vaccine. Only the live attenuated Ty21a strain is affected.
Ethanol/Nutrition/Herb Interactions
Ethanol: Chronic ethanol ingestion may reduce the serum concentration of doxycycline.
Food: Doxycycline serum levels may be slightly decreased if taken with food or milk. Administration with iron or calcium may decrease doxycycline absorption. May decrease absorption of calcium, iron, magnesium, zinc, and amino acids.
Herb/Nutraceutical: St John's wort may decrease doxycycline levels. Avoid dong quai, St John's wort (may also cause photosensitization).
Storage
Capsule, tablet: Store at controlled room temperature 15°C to 30°C (59°F to 86°F). Protect from light.
I.V. infusion: Protect from light. Stability varies based on solution.
Reconstitution
I.V. infusion: Following reconstitution with sterile water for injection, dilute to a final concentration of 0.1-1 mg/mL using a compatible solution.
Compatibility
Solutions for I.V. infusion are stable in NS, D5W, Ringer's injection, LR, D5LR.
Y-site administration: Compatible: Acyclovir, amifostine, amiodarone, aztreonam, cisatracurium, cyclophosphamide, diltiazem, docetaxel, etoposide, filgrastim, fludarabine, gemcitabine, granisetron, hetastarch, hydromorphone, magnesium sulfate, melphalan, meperidine, morphine, ondansetron, perphenazine, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine. Incompatible: Allopurinol, heparin, piperacillin/tazobactam. Variable (consult detailed reference): Meropenem.
Compatibility in syringe: Compatible: Doxapram.
Compatibility when admixed: Compatible: Ranitidine. Variable (consult detailed reference): Meropenem.
Mechanism of Action
Inhibits protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit(s) of susceptible bacteria; may also cause alterations in the cytoplasmic membrane
Periostat® capsules (proposed mechanism): Has been shown to inhibit collagenase activity in vitro. Also has been noted to reduce elevated collagenase activity in the gingival crevicular fluid of patients with periodontal disease. Systemic levels do not reach inhibitory concentrations against bacteria.
Pharmacodynamics/Kinetics
Absorption: Oral: Almost complete
Distribution: Widely into body tissues and fluids including synovial, pleural, prostatic, seminal fluids, and bronchial secretions; saliva, aqueous humor, and CSF penetration is poor
Protein binding: 90%
Metabolism: Not hepatic; partially inactivated in GI tract by chelate formation
Half-life elimination: 12-15 hours (usually increases to 22-24 hours with multiple doses); End-stage renal disease: 18-25 hours
Time to peak, serum: 1.5-4 hours
Excretion: Feces (30%); urine (23%)
Dosage
Usual dosage range:
Children >8 years (<45 kg): Oral, I.V.: 2-5 mg/kg/day in 1-2 divided doses, not to exceed 200 mg/day
Children >8 years (>45 kg) and Adults: Oral, I.V.: 100-200 mg/day in 1-2 divided doses
Indication-specific dosing:
Children:
Anthrax: Doxycycline should be used in children if antibiotic susceptibility testing, exhaustion of drug supplies, or allergic reaction preclude use of penicillin or ciprofloxacin. For treatment, the consensus recommendation does not include a loading dose for doxycycline.
Inhalational (postexposure prophylaxis) (MMWR, 2001, 50:889-893): Oral, I.V. (use oral route when possible):
?8 years: 2.2 mg/kg every 12 hours for 60 days
>8 years and ?45 kg: 2.2 mg/kg every 12 hours for 60 days
>8 years and >45 kg: 100 mg every 12 hours for 60 days
Cutaneous (treatment): Oral: See dosing for “Inhalational (postexposure prophylaxis)”
Note: In the presence of systemic involvement, extensive edema, and/or lesions on head/neck, doxycycline should initially be administered I.V.
Inhalational/gastrointestinal/oropharyngeal (treatment): I.V.: Refer to dosing for inhalational anthrax (postexposure prophylaxis); switch to oral therapy when clinically appropriate
Note: Initial treatment should include two or more agents predicted to be effective (per CDC recommendations). Agents suggested for use in conjunction with doxycycline or ciprofloxacin include rifampin, vancomycin, imipenem, penicillin, ampicillin, chloramphenicol, clindamycin, and clarithromycin. May switch to oral antimicrobial therapy when clinically appropriate. Continue combined therapy for 60 days
Children ?8 years:
Malaria prophylaxis: Oral: 2 mg/kg/day (maximum 100 mg/day). Start 1-2 days prior to travel to endemic area; continue daily during travel and for 4 weeks after leaving endemic area
Children ?8 years (and >45 kg) and Adults:
Chlamydial infections, uncomplicated: Oral: 100 mg twice daily for ?7 days
Lyme disease, Q fever, or tularemia: Oral: 100 mg twice daily for 14-21 days
Rickettsial disease or ehrlichiosis: Oral, I.V.: 100 mg twice daily for 7-14 days
Adults:
Anthrax:
Inhalational (postexposure prophylaxis): Oral, I.V. (use oral route when possible): 100 mg every 12 hours for 60 days (MMWR, 2001, 50:889-93); Note: Preliminary recommendation, FDA review and update is anticipated.
Cutaneous (treatment): Oral: 100 mg every 12 hours for 60 days. Note: In the presence of systemic involvement, extensive edema, lesions on head/neck, refer to I.V. dosing for treatment of inhalational/gastrointestinal/oropharyngeal anthrax
Inhalational/gastrointestinal/oropharyngeal (treatment): I.V.: Initial: 100 mg every 12 hours; switch to oral therapy when clinically appropriate; some recommend initial loading dose of 200 mg, followed by 100 mg every 8-12 hours (JAMA, 1997, 278:399-411). Note: Initial treatment should include two or more agents predicted to be effective (per CDC recommendations). Agents suggested for use in conjunction with doxycycline or ciprofloxacin include rifampin, vancomycin, imipenem, penicillin, ampicillin, chloramphenicol, clindamycin, and clarithromycin. May switch to oral antimicrobial therapy when clinically appropriate. Continue combined therapy for 60 days
Brucellosis: Oral: 100 mg twice daily for 6 weeks with rifampin or streptomycin
Community-acquired pneumonia, bronchitis: Oral, I.V.: 100 mg twice daily
Endometritis, salpingitis, parametritis, or peritonitis: I.V.: 100 mg twice daily with cefoxitin 2 g every 6 hours for 4 days and for ?48 hours after patient improves; then continue with oral therapy 100 mg twice daily to complete a 10- to 14-day course of therapy
Gonococcal infection, acute (PID) in combination with another antibiotic: I.V.: 100 mg every 12 hours until improved, followed by 100 mg orally twice daily to complete 14 days
Malaria prophylaxis: 100 mg/day. Start 1-2 days prior to travel to endemic area; continue daily during travel and for 4 weeks after leaving endemic area
Nongonococcal urethritis: Oral: 100 mg twice daily for 7 days
Periodontitis: Oral (Periostat®): 20 mg twice daily as an adjunct following scaling and root planing; may be administered for up to 9 months. Safety beyond 12 months of treatment and efficacy beyond 9 months of treatment have not been established.
Rosacea: (Oracea™): Oral: 40 mg once daily in the morning
Sclerosing agent for pleural effusion injection (unlabeled use): Irrigation: 500 mg as a single dose in 30-50 mL of NS or SWI
Syphilis:
Early syphilis: Oral, I.V.: 200 mg/day in divided doses for 14 days
Late syphilis: Oral, I.V.: 200 mg/day in divided doses for 28 days
Yersinia pestis
(plague): Oral: 100 mg twice daily for 7 days
Vibrio cholerae:
Oral: 300 mg as a single dose
Dosing adjustment in renal impairment: No adjustment necessary
Dialysis: Not dialyzable; 0% to 5% by hemo- and peritoneal methods or by continuous arteriovenous or venovenous hemofiltration: No supplemental dosage necessary
Dental Usual Dosing
Adults: Oral: Treatment of periodontal disease: 100-200 mg once daily for 21 days. Note: A specific formulation (Periostat®) containing a subantimicrobial dosage is also available for use as an adjunct to scaling and root planing (see Doxycycline Subantimicrobial monograph). In addition, doxycycline gel (Atridox™) is available for subgingival application (see Doxycycline Hyclate Periodontal Extended-Release Liquid monograph).
Administration: Oral
May give with meals to decrease GI upset. Capsule and tablet: Administer with at least 8 ounces of water and have patient sit up for at least 30 minutes after taking to reduce the risk of esophageal irritation and ulceration.
Oracea™: Take on an empty stomach 1 hour before or 2 hours after meals.
Doryx®: May be administered by carefully breaking up the tablet and sprinkling tablet contents on a spoonful of applesauce. The delayed release pellets must not be crushed or damaged when breaking up tablet. Should be administered immediately after preparation and without chewing.
Administration: I.V.
Infuse slowly, usually over 1-4 hours. Avoid extravasation.
Administration: I.V. Detail
Avoid extravasation. Very irritating to vein; use central line if possible.
pH: 1.8-3.3 (reconstituted solution)
Test Interactions
False elevations of urine catecholamine levels; false-negative urine glucose using Clinistix®, Tes-Tape®
Dietary Considerations
Tetracyclines (in general): Take with food if gastric irritation occurs. While administration with food may decrease GI absorption of doxycycline by up to 20%, administration on an empty stomach is not recommended due to GI intolerance. Of currently available tetracyclines, doxycycline has the least affinity for calcium.
Oracea™: Take on an empty stomach 1 hour before or 2 hours after meals.
Doryx® 75 mg and 100 mg tablets contain sodium 4.5 mg and 6 mg, respectively.
Patient Education
If administered by infusion, report immediately any acute back pain, difficulty breathing or swallowing, chest tightness, pain, redness, or swelling at infusion site. Oral: Do not take any new medication during therapy unless approved by prescriber. Take entire prescription as directed, even if you are feeling better. Follow exact directions for administering the form of drug you are using (eg, tablet, capsules, liquid, or delayed release). Generally, the medication may be taken with food if gastric irritation occurs. Avoid alcohol and maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. If you have diabetes, drug may cause false test results with Clinistix® urine glucose monitoring; use of another form of glucose monitoring is recommended. You may be sensitive to sunlight (use sunblock, wear protective clothing and eyewear, or avoid exposure to direct sunlight). May cause nausea or vomiting (small frequent meals, frequent mouth care, or sucking lozenges may help) or diarrhea (buttermilk, boiled milk, or yogurt may help). Report skin rash or itching; easy bruising or bleeding; yellowing of skin or eyes; pale stool or dark urine; unhealed mouth sores; vaginal itching or discharge; persistent diarrhea; and fever, chills, or unusual cough. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Do not get pregnant while taking this medication. Consult prescriber for appropriate barrier contraceptive measures. Breast-feeding is not recommended.
Geriatric Considerations
Dose adjustment for renal function is not necessary.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Glossitis and tooth discoloration (children). Opportunistic “superinfection” with Candida albicans; tetracyclines are not recommended for use during pregnancy or in children ?8 years of age since they have been reported to cause enamel hypoplasia and permanent teeth discoloration. The use of tetracyclines should only be used in these patients if other agents are contraindicated or alternative antimicrobials will not eradicate the organism.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
Tetracyclines have been reported to cause memory disturbance, mood stabilizing and antidepressant effects
Mental Health: Effects on Psychiatric Treatment
May cause neutropenia; use caution with clozapine and carbamazepine; barbiturates and carbamazepine increase the clearance of doxycycline
Nursing: Physical Assessment/Monitoring
Assess results of culture and sensitivity test and patient's allergy history prior to beginning therapy. Assess potential for interactions with other pharmacologic agents or herbal products patient may be taking. IV: Infusion site must be closely monitored; extravasation can be very irritating to veins (use of central line is preferable). Assess therapeutic effectiveness (according to purpose for use) and adverse response on a regular basis throughout therapy. Advise patients with diabetes about use of Clinistix® (may cause false-negative). Teach patient appropriate use/administration (oral), possible side effects, interventions to reduce side effects (eg, importance of adequate hydration, photosensitivity precautions), and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Note: Strength expressed as base.
Capsule, as hyclate: 50 mg, 100 mg
Vibramycin®: 100 mg
Capsule, as monohydrate: 50 mg, 100 mg
Monodox®: 50 mg, 75 mg, 100 mg
Capsule, variable release:
Oracea™: 40 mg [30 mg (immediate-release) and 10 mg (delayed-release)]
Injection, powder for reconstitution, as hyclate: 100 mg
Doxy-100®: 100 mg
Powder for oral suspension, as monohydrate:
Vibramycin®: 25 mg/5 mL (60 mL) [raspberry flavor]
Syrup, as calcium:
Vibramycin®: 50 mg/5 mL (480 mL) [contains sodium metabisulfite; raspberry-apple flavor]
Tablet, as hyclate: 20 mg, 100 mg
Periostat®: 20 mg
Vibra-Tabs®: 100 mg
Tablet, as monohydrate: 50 mg, 75 mg, 100 mg, 150 mg
Adoxa®: 50 mg, 75 mg, 100 mg
Adoxa® Pak™ 1/75 [unit-dose pack]: 75 mg (31s)
Adoxa® Pak™ 1/100 [unit-dose pack]: 100 mg (31s)
Adoxa® Pak™ 1/150 [unit-dose pack]: 150 mg (30s)
Adoxa® Pak™ 2/100 [unit-dose pack]: 100 mg (60s)
Tablet, delayed-release coated pellets, as hyclate:
Doryx®: 75 mg [contains sodium 4.5 mg (0.196 mEq)], 100 mg [contains sodium 6 mg (0.261 mEq)]
Pricing: U.S. (www.drugstore.com)
Capsule, delayed release (Oracea)
40 mg (30): $169.99
Capsules (Doxycycline Hyclate)
50 mg (20): $12.99
100 mg (30): $12.99
Capsules (Doxycycline Monohydrate)
50 mg (30): $29.99
Capsules (Vibramycin)
100 mg (20): $129.13
Suspension (reconstituted) (Vibramycin)
25 mg/5 mL (60): $29.99
Syrup (Vibramycin)
50 mg/5 mL (480): $251.95
Tablet, EC (Doryx)
75 mg (30): $201.19
Tablets (Adoxa)
75 mg (30): $207.99
100 mg (30): $221.54
Tablets (Adoxa Pak 1/100)
100 mg (31): $210.88
Tablets (Adoxa Pak 1/150)
150 mg (30): $338.92
Tablets (Adoxa Pak 2/100)
100 mg (60): $423.48
Tablets (Doxycycline Hyclate)
20 mg (30): $31.99
100 mg (20): $13.99
Tablets (Periostat)
20 mg (100): $237.35
Tablets (Vibra-Tabs)
100 mg (20): $129.13
Extemporaneously Prepared
If liquid doxycycline is unavailable for the treatment of anthrax, emergency doses may be prepared for children using the tablets.
Crush one 100 mg tablet and grind into a fine powder. Mix with 4 teaspoons of food or drink (lowfat milk, chocolate milk, chocolate pudding, or apple juice). Appropriate dose may be taken from this mixture. Mixture may be stored for up to 24 hours. Dairy mixtures should be refrigerated; apple juice may be stored at room temperature.
U.S. Food and Drug Administration, Center for Drug Evaluation and Research, “How to Prepare Emergency Dosages of Doxycycline at Home for Infants and Children,” April 25, 2003, viewable at http://www.fda.gov/cder/drug/infopage/penG_doxy/doxycyclinePeds.htm, last accessed May 8, 2003.
References
Abramowicz M, “Antimicrobial Prophylaxis in Surgery,” Medical Letter on Drugs and Therapeutics, Handbook of Antimicrobial Therapy, 16th ed, New York, NY: Medical Letter, 2002.
Böcker R, Mühlberg W, Platt D, et al, “Serum Level, Half-Life and Apparent Volume of Distribution of Doxycycline in Geriatric Patients,” Eur J Clin Pharmacol, 1986, 30(1):105-8.
Bryant SG, Fisher S, and Kluge RM, “Increased Frequency of Doxycycline Side Effects,” Pharmacotherapy, 1987, 7(4):125-9.
Centers for Disease Control and Prevention, "Sexually Transmitted Diseases Treatment Guidelines, 2006," MMWR, 2006, 55(RR-11): 1-94.
Centers for Disease Control and Prevention, “Update: Investigation of Anthrax Associated With Intentional Exposure and Interim Public Health Guidelines, October 2001,” MMWR, 2001, 50(41):889-93, accessed October 19, 2001. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5041a1.htm.
Centers for Disease Control and Prevention, “Update: Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy, October 2001,” MMWR, October 26, 2001, 50(42):909-19. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5042a1.htm. Accessed October 26, 2001.
Daunt N, Brodribb TR, and Dickey JD, “Oesophageal Ulceration Due to Doxycycline,” Br J Radiol, 1985, 58(696):1209-11.
Francke EL and Neu HC, “Chloramphenicol and Tetracyclines,” Med Clin North Am, 1987, 71(6):155-68.
Joshi N and Miller DQ, “Doxycycline Revisited,” Arch Intern Med, 1997, 157(13):1421-8.
Ljungberg B and Nilsson-Ehle I, “Pharmacokinetics of Antimicrobial Agents in the Elderly,” Rev Infect Dis, 1987, 9(2):250-64.
Rams TE and Slots J, “Antibiotics in Periodontal Therapy: An Update,” Compendium, 1992, 13(12):1130, 1132, 1134.
Saivin S and Hovin G, “Clinical Pharmacokinetics of Doxycycline and Minocycline,” Clin Pharmacokinet, 1985, 15:355-66.
Smilack JD, Wilson WR, and Cockerill FR 3d, “Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole,” Mayo Clin Proc, 1991, 66(12):1270-80.
Wilson WR and Cockerill FR 3d, “Tetracyclines, Chloramphenicol, Erythromycin, and Clindamycin,” Mayo Clin Proc, 1987, 62(10):906-15.
Wyler DJ, “Malaria: Overview and Update,” Clin Infect Dis, 1993, 16(4):449-56.
International Brand Names
Lexi-Comp.com
Last full review/revision May 2008
Content last modified May 2008
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