Doxycycline

Generic name
Doxycycline
Brand name
ATC Code
J01AA02
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Doxycycline

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

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Bacterial infections
  • Oral
    • ≥ 8 years and < 45 kg
      [2]
      • Initial dose: 4.4 mg/kg/day in 1 dose
      • Maintenance dose: 2.2 mg/kg/day in 1 dose
    • ≥ 45 kg
      [2]
      • Initial dose: 200 mg/day in 1 dose
      • Maintenance dose: 100 mg/day in 1 dose
  • Intravenous
    • ≥ 8 years and < 45 kg
      [2]
      • Initial dose: 4.4 mg/kg/day in 1 dose
      • Maintenance dose: 2.2 mg/kg/day in 1 dose
    • ≥ 45 kg
      [2]
      • Initial dose: 200 mg/day in 1 dose
      • Maintenance dose: 100 mg/day in 1 dose
Severe bacterial infections
  • Oral
    • ≥ 8 years and < 45 kg
      [2]
      • Initial dose: 4.4 mg/kg/day in 1 dose
      • Maintenance dose: 4.4 mg/kg/day in 2 doses.
    • ≥ 45 kg
      [2]
      • Initial dose: 200 mg/day in 1 dose
      • Maintenance dose: 200 mg/day in 2 doses.
  • Intravenous
    • ≥ 8 years and < 45 kg
      [2]
      • Initial dose: 4.4 mg/kg/day in 1 dose
      • Maintenance dose: 4.4 mg/kg/day in 2 doses.
    • ≥ 45 kg
      [2]
      • Initial dose: 200 mg/day in 1 dose
      • Maintenance dose: 200 mg/day in 2 doses.
Infection in cystic fibrosis
  • Oral
    • 8 years up to 18 years
      [1]
      • Initial dose: 5 mg/kg/day, once only.
      • Maintenance dose: 5 mg/kg/day in 1 - 2 doses. Max: 200 mg/day.
Early localized, disseminated and late Lyme disease
  • Oral
    • ≥ 8 years and < 45 kg
      [2] [3]
      • 4.4 mg/kg/day in 2 doses.
      • Duration of treatment:
        • Early localized Lyme disease: 10 days
        • Lyme meningitis, facial paresis without cell reaction in the CSF: 14 days
        • Early disseminated lyme disease other than meningitis and lyme arthritis: 21 days
        • Late Lyme disease and Lyme arthritis: 30 days
        • Chronic neuroborreliosis with pleiocytosis in the CSF: 30 days
    • ≥ 45 kg
      [2] [3]
      • 200 mg/day in 2 doses.
      • Duration of treatment:
        • Early localised lyme disease: 10 days
        • Lyme meningitis, facial paresis without cell reaction in the liquor: 14 days
        • Early disseminated lyme disease other than meningitis and lyme arthritis: 21 days
        • Late lyme disease and lyme arthritis: 30 days
        • Chronic neuroborreliosis without pleiocytosis in the liquor: 30 days

        (duration of treatment based on Dutch guideline; adjust to local guidelines if needed)
Prophylaxis after a tick bite
Treatment of uncomplicated malaria
  • Oral
    • ≥ 8 years
      [4]
      • 4.4 mg/kg/day in 2 doses. Max: 200 mg/day.
      • Duration of treatment:

        At least 7 days

      • Always give in combination with a schizonticide.
Prophylaxis for malaria
  • Oral
    • ≥ 8 years
      [5]
      • 2.2 mg/kg/day in 1 dose Max single dose: 100 mg/dose.
      • Duration of treatment:

        Commence on the day of arrival in a region where malaria is endemic; take while staying there and continue until 4 weeks after leaving the endemic area

Renal impaiment in children > 3 months

GFR ≥10 ml/min/1.73m2: Dose adjustment not required.

GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

(irreversible) tooth discoloration in children, disorders of dental development

Recent observational studies indicate that doxycycine treatment of small children does not seem to induce permananent tooth discoloration [Todd 2015, Biggs 2016, Poyhonen 2017, Volovitz 2007]. Therefore, doxycycline - which binds less to calcium than tetracycline - can be considered in younger children (< 8 years) when alternative treatment options are lacking.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications in children

Use in children <8 years, because of the risk of damage to growing bone and dental tissue and irreversible discoloration (yellow / gray / brown) of the teeth, unless the condition is very serious and there is no other treatment option; with facial rosacea <12 years; 

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Permanent discoloration of developing teeth: With use of tetracyclines during the second half of pregnancy or in children up to and including 8 years of age, enamel hypoplasia and permanent discoloration (yellow-gray-brown) of the teeth have been reported. This side effect is more common with long-term use of tetracyclines, but has also been reported after repeated short-term use. Use of doxycycline in children <8 years of age is contraindicated, except in severe or life-threatening conditions (eg 'Rocky Mountain spotted fever'), especially when there is no other treatment option. Consider use in children 8–12 years only if other drugs are ineffective, contraindicated or unavailable.

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

TETRACYCLINES

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

References

  1. Hartwig NC, et al, Vademecum pediatrische antimicrobiële therapie, 2005
  2. Teva, SPC Doxycycline (RVG 09519) 06-11-2018, www.cbg-meb.nl
  3. CBO, Richlijn Lymeziekte, www.cbo.nl, 2013
  4. Aurobindo, SmPC Doxycycline (RVG12871) 12-11-2018, www.cbg-meb.nl
  5. Landelijk Coordinatiecentrum Reizigers Advisering, Malariaprofylaxe bulletin, 2015, Feb
  6. Wichers IM et al, NHG Behandelrichtlijn tekenbeet, 2017
  7. Biggs HM, et al., Diagnosis and management of tickborne rickettsial diseases: Rocky mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis - United States, MMWR Recomm Rep, 2016, 65(2), 1-44
  8. Volovitz B, et al., Absence of tooth staining with doxycycline treatment in young children, Clin Pediatr, 2007, 46(2), 121-6
  9. Poyhonen H, et al., Dental staining after doxycycline use in children, J Antimicrob Chemoth, 2017, 72(10), 2887-90
  10. Todd SR, et al., No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever, J Pediatr, 2015, 166(5), 1246-51
  11. Dermapharm, SmPC Doxyderma 50 mg (11619.00.00), 06/2016
  12. Ratiopharm , SmPC Doxy-M-ratiopharm Tabletten (16390.00.00/ 16390.01.00), 11/2017
  13. Lalloo, D.G., et al., UK malaria treatment guidelines 2016, J Infect, 2016, 72(6), 635-649
  14. Hexal, SmPC DoxyHEXAL SF (14975.00.00), 04/2017
  15. Aliud Pharma , SmPC Doxycyclin AL (10543.00.00/ 10543.01.00/ 8552.00.00/ 8184.00.00), 12/2017
  16. Hexal , SmPC DoxyHEXAL® tabs 100 mg Tabletten/ DoxyHEXAL® 200 mg tabs Tabletten (7481.00.00/ 7481.01.00), 10/2016
  17. GALENpharma, SmPC Doxakne tabs (1230.02.00), 05/2015
  18. Ratiopharm , SmPC Doxycyclin-ratiopharm SF (576.00.01), 11/2017
  19. Galderma Laboratorium , SmPC Oraycea 40 mg Hartkapseln mit veränderter Wirkstofffreisetzung (65881.00.00), 09/2017
  20. Robert Koch Institut , "Ratgeber für Ärzte - Malaria", abgerufen: 20.03.2018
  21. Ratiopharm, SmPC Doxycyclin-ratiopharm 100 mg Weichkapseln (576.00.00), 11/2017
  22. Dermapharm , SmPC Doxyderma 100 mg (16637.00.00), 03/2016
  23. Deutsche Dermatologische Gesellschaft (DDG), Kutane Lyme Borreliose, S2k Leitlinie, 2016

Changes

Therapeutic Drug Monitoring


Overdose