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    When penicillin is contraindicated, doxycycline is an alternative drug in the treatment of the following infections: -Syphilis caused by Treponema pallidum -Yaws caused by Treponema pallidum subspecies pertenue -Listeriosis due to Listeria monocytogenes -Vincent’s infection caused by Fusobacterium fusiforme -Actinomycosis caused by Actinomyces israelii -Infections caused by Clostridium species CDC STD guidelines: MMWR Recomm Rep. June 5, 20(RR3);1-137 Uncomplicated gonococcal infection of the cervix, urethra, and rectum: Ceftriaxone 250 mg IM once plus azithromycin 1 g PO once (preferred) or alternatively doxycycline 100 mg PO q12hr for 7 days Uncomplicated urethral, endocervical, or rectal infection caused by Chlamydia trachomatis: 100 mg PO BID x 7 days Nongonococcal urethritis caused by C. urealyticum: 100 mg PO BID x 7 days Syphilis (early): Patients who are allergic to penicillin should be treated with doxycycline 100 mg PO BID x 2 weeks Syphilis 1 year duration: Patients who are allergic to penicillin should be treated with doxycycline 100 mg PO BID x 4 weeks Acute epididymo-orchitis caused by N. gonorrhoeae or C trachomatis: 100 mg PO BID x least 10 days Equivalent dose of Doryx MPC is 120 mg PO BID Trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated as judged by immunofluorescence; also approved for inclusion conjunctivitis caused by chlamydia trachomatis 100 PO q12hr on day 1, then 100 mg PO q Day Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1, then 120 mg PO q Day Indicated for Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsial pox, and tick fevers caused by Rickettsiae 100 PO q12hr on day 1, then 100 mg PO q Day Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1, then 120 mg PO q Day Suspected Bartonella infection with a negative culture: 100 mg PO BID x 6 weeks in combination with gentamicin and ceftriaxone Positive culture Bartonella infection: 100 mg PO BID x 6 weeks in combination with gentamicin or rifampin Equivalent dose of Doryx MPC is 120 mg PO BID Single dose: 7 mg/kg PO/IV; not to exceed 300 mg/dose; adjunct to fluid and electrolyte replacement Multiple dose: 2 mg/kg PO/IV twice daily on day 1; THEN, 2 mg/kg q Day on days 2 and 3; not to exceed 100 mg/dose; adjunct to fluid and electrolyte replacement Anorexia Dental discoloration Diarrhea Dysphagia Enterocolitis Erythema multiform Esophageal ulcer Esophagitis Exacerbation of systemic lupus erythematosus Exfoliative dermatitis Glossitis Headache Hemolytic anemia Hepatotoxicity Hypoglycemia Inflammatory anogenital lesion Intracranial hypertension Nausea Neutropenia Pericarditis Serum sickness Skin hyperpigmentation Toxic epidermal necrolysis Thrombocytopenia Upper abdominal pain Urticaria Vomiting Drug rash with eosinophilia and systemic symptoms Not drug of choice for any staphylococcal infection Risk of thrombophlebitis when given IV History of candidiasis overgrowth Hepatotoxicity may occur; if symptoms occur, measure LFTs and discontinue drug Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment May increase BUN due to its anti-anabolic effects; use caution in patients with renal impairment Consider drug serum level determinations in prolonged therapy Tetracycline use during tooth development (last half of pregnancy through age 8 years) can cause permanent discoloration of teeth; use doxycycline in pediatric patients 8 years of age or less only when potential benefits expected to outweigh risks in severe or life-threatening conditions (e.g., anthrax, Rocky Mountain spotted fever); particularly when there are no alternative therapies Superficial discoloration of adult permanent dentition, reversible upon drug discontinuation and professional dental cleaning has reported; permanent tooth discoloration and enamel hypoplasia may occur with drugs of tetracycline class when used during tooth development Fanconi-like syndrome may occur with outdated tetracyclines Intracranial hypertension (pseudotumor cerebri) reported (rare) may occur; symptoms include headache, blurred vision, diplopia, and vision loss; papilledema can be found on funduscopy; women of childbearing age who are overweight or have a history of IH are at greater risk; possibility for permanent visual loss exists; if visual disturbance occurs during treatment, prompt ophthalmologic evaluation is warranted; intracranial pressure can remain elevated for weeks after drug cessation; monitor patients until they stabilize Doxycycline offers substantial but not complete suppression of asexual blood stages of Plasmodium strains; doxycycline does not suppress P. falciparum’s sexual blood stage gametocytes; subjects completing prophylactic regimen may still transmit infection to mosquitoes outside endemic areas Prolonged use may result in superinfection Overgrowth of non-susceptible organisms, including fungi, may occur; if such infections occur, discontinue use and institute appropriate therapy May induce hyperpigmentation in many organs including skin, eyes, nails, thyroid and bone If Clostridium difficile associated diarrhea suspected or confirmed, may need to discontinue ongoing antibacterial use not directed against C. difficile; may also need to institute appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation as clinically indicated Use in pediatric patients 8 years of age or less only when potential benefits are expected to outweigh risks in severe or life-threatening conditions (e.g., anthrax, Rocky Mountain spotted fever), particularly when there are no alternative therapies Severe skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) reported; if severe skin reactions occur, discontinue therapy immediately and institute appropriate therapy Not studied in pregnant patients; the vast majority of reported experience with doxycycline during human pregnancy is short-term, first trimester exposure; there are no human data available to assess effects of long-term therapy of doxycycline in pregnant women, such as that proposed for treatment of anthrax exposure; it should not be used in pregnant women unless, in judgment of physician, it is essential for welfare of patient; evidence of embryotoxicity has been noted in animals treated early in pregnancy Tetracyclines are excreted in human milk; however, extent of absorption of tetracyclines, including doxycycline, by breastfed infant is not known; short-term use by lactating women is not necessarily contraindicated; however, effects of prolonged exposure to doxycycline in breast milk are unknown;11 because of potential for serious adverse reactions in nursing infants from doxycycline, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account importance of drug to mother Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria; may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. 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