2 mg/kg/dose (Max: 100 mg/dose) PO every 12 hours for 12 to 20 weeks plus sulfamethoxazole; trimethoprim for 12 to 20 weeks with or without chloramphenicol for 8 weeks as maintenance therapy after completing at least 10 to 14 days of parenteral therapy. 2.6 mg/kg/dose (Max: 120 mg/dose) PO every 12 hours as an alternative for at least 3 weeks and until all lesions have completely healed. The absorption of tetracyclines may be reduced by chelation with magnesium sulfate. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Continue 100 mg PO every 12 hours for severe infections. Efficacy beyond 16 weeks and safety beyond 9 months have not been established. 2.2 mg/kg/dose (Max: 100 mg/dose) IV every 12 hours for 14 days. Guidelines recommend this regimen as a first-line treatment option. Tetracyclines may decrease intestinal absorption of methotrexate or interfere with the enterohepatic circulation by inhibiting bowel flora and suppressing metabolism of methotrexate by bacteria. 2.2 mg/kg/dose PO every 12 hours for 10 to 14 days. Multivitamins containing manganese or zinc salts will also decrease absorption. Several other mechanisms have been proposed but not studied. Doxycycline calcium oral suspension contains sodium metabisulfite. The dose is dependent on the size, shape, and number of pockets being treated. Aluminum Hydroxide; Magnesium Hydroxide: (Moderate) Separate administration of oral doxycycline and antacids by 2 to 3 hours. Calcium Carbonate; Risedronate: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. Ethinyl Estradiol; Norgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. 120 mg PO every 12 hours for 6 to 12 months after IV therapy. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients infected after intentional release of Y. pestis. The oral absorption of certain tetracycline class antibiotics will be reduced by agents containing these cations (e.g., calcium) and it is often recommended to avoid administration within 1 to 2 hours of interfering foods (e.g., dairy products). Pseudotumor cerebri has been reported with systemic retionoid use alone and early signs and symptoms include papilledema, headache, nausea, vomiting and visual disturbances. Calcium Carbonate: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. 100 mg PO every 12 to 24 hours for 7 to 10 days. Clinicians should keep in mind that larger doses of doxycycline may be necessary in patients receiving barbiturates. 100 mg PO every 12 hours if a relapse occurs after at least 3 months of treatment. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Serum half-life ranges from 12 to 25 hours, depending on single or multiple dosage, in adults with normal renal function. 2.2 to 4.4 mg/kg/day (Max: 200 mg/day) IV divided every 12 hours for at least 3 months. Bacterial protein synthesis is inhibited, which ultimately accounts for the antibacterial action. When a single dose of Doryx MPC was administered with a high-fat, high-calorie meal, the Cmax was approximately 30% lower, but there was no significant difference in AUC compared to fasting conditions. 100 mg PO every 12 hours for 7 days as first-line therapy for mild or moderate disease. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. 100 mg PO every 12 hours for 14 days. 2.2 mg/kg/dose (Max: 100 mg/dose) PO every 12 hours until afebrile for at least 3 days and clinical improvement; 4.4 mg/kg/dose (Max: 200 mg/dose) PO as a single dose may be effective in halting outbreaks, although some patients may relapse. Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Major) Although doxycycline is not appreciably metabolized by the liver, concomitant use of rifampin has been shown to substantially increase doxycycline clearance. Some manufacturers state that absorption of oral doxycycline is not markedly influenced by simultaneous ingestion of food or milk and recommend taking doxycycline with food or milk if gastric irritation occurs upon administration. Duration of treatment is dependent on serologic response. Doxycycline is an alternative for the treatment of systemic anthrax without CNS involvement. Guide treatment duration by clinical stability. Binding of doxycycline blocks the binding of aminoacyl transfer RNA (tRNA) to the messenger RNA (mRNA). (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. 2.2 mg/kg/dose (Max: 100 mg/dose) PO every 12 hours for 14 days. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Phenoxymethylpenicillin. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. Doxycycline can make birth control pills less effective. the american college of obstetricians and gynecologists concluded that tetracycline (sumycin), doxycycline (vibramycin), ampicillin,. Doxycycline can make birth control pills less effective. This antibiotic does not decrease the effectiveness of birth control. 100 mg PO every 12 hours or 200 mg PO once daily for 21 to 28 days. 100 mg PO every 12 hours or 200 mg PO once daily for 14 to 21 days for patients with mild disease not requiring hospitalization (i.e., first degree AV block with PR interval less than 300 milliseconds) or as appropriate oral stepdown treatment after IV therapy in hospitalized patients with severe disease (i.e., symptomatic, first degree AV block with PR interval 300 milliseconds or greater, second or third degree AV block). 2.2 to 4.4 mg/kg/day (Max: 200 mg/day) IV divided every 12 hours for at least 6 weeks plus gentamicin for 2 weeks or rifampin for at least 6 weeks. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Treat for 5 days for children with mild or uncomplicated illness; if patient remains febrile after 5 days of treatment, switch to sulfamethoxazole; trimethoprim therapy. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. Bacterostatic antibacterials like tetracyclines may antagonize the bactericidal effects of penicillins which may reduce their efficacy. In a single-dose food effect study, the Cmax and AUC of doxycycline (given as Oracea) were reduced by about 45% and 22%, respectively, in healthy volunteers fed a 1,000-calorie, high-fat, high-protein meal which included dairy products. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients and patients infected after intentional release of Y. pestis. Zinc: (Major) Concurrent administration of oral zinc salts with oral tetracyclines can decrease the absorption of these antiinfectives and possibly interfere with their therapeutic response. Make sure your dog has access to plenty of fresh water with this medication and give with food. 2.6 mg/kg/dose (Max: 120 mg/dose) PO every 12 hours for 60 days after exposure. 2.6 mg/kg/dose (Max: 120 mg/dose) PO every 12 hours for 14 days. It is possible that extrahepatic sites of metabolism (e.g., intestinal mucosa) may be involved since P-450 cytochrome enzymes have been identified in areas such as adrenal cortex, intestinal mucosa, and kidney. The FDA-approved dosage is 2.2 mg/kg/dose (Max: 100 mg/dose) PO every 12 hours on day 1, then 1.1 mg/kg/dose (Max: 50 mg/dose) PO every 12 hours or 2.2 mg/kg/dose (Max: 100 mg/dose) PO once daily. [32075], 200 mg/day IV divided every 12 to 24 hours on day 1, then 100 to 200 mg/day IV with the 200 mg/day dose divided every 12 to 24 hours. No association was seen when the analysis was confined to maternal treatment during the period of organogenesis (i.e., in the second and third months of gestation) with the exception of a marginal relationship with neural tube defect based on only 2 exposed cases. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Bacillus Calmette-Guerin Vaccine, BCG: (Major) Doxycycline may interfere with the effectiveness of Bacillus Calmette-Guerin Live, BCG. Continue 100 mg PO every 12 hours for severe infections. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. Doxycycline half-life was decreased from 15.3 hours to 11.1 hours. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Antiinfectives and Antiseptics for Local Oral TreatmentNatural and Semi-Synthetic Tetracycline AntibioticsOral Non-Retinoids for AcneOral Rosacea Agents. Less than 45 kg:Oral immediate and delayed-release formulations excluding Doryx MPC and periodontal dosage formulations: 4.4 mg/kg/day PO.Intravenous formulation: 4.4 mg/kg/day IV.Doryx MPC: 5.3 mg/kg/day PO. 2 to 4.4 mg/kg/dose (Max: 300 mg/dose) PO as a single dose as first-line therapy. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. There are no data available on the risk of miscarriage after doxycycline exposure. 100 mg PO twice daily on day 1, then 100 mg PO once daily or 50 mg PO twice daily for 10 to 21 days. However, conflicting data have been reported, and further study is needed. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Shorter courses may be appropriate for less extensive infections. In gram-negative bacteria, transportation of the drug into the cell occurs either by passive diffusion or through an energy-dependent active transport system. 200 mg IV on day 1, then 100 to 200 mg/day IV with the 200 mg/day dose divided every 12 to 24 hours for 7 to 14 days for mild infections due to methicillin-resistant S. aureus (MRSA) or other staphylococci or streptococci in patients allergic or intolerant to beta-lactams or moderate or severe infections in patients with risk factors for MRSA. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. 4.4 mg/kg/dose (Max: 200 mg/dose) PO on day 1, then 2.2 mg/kg/dose (Max: 100 mg/dose) PO once daily or every 12 hours for 5 to 10 days plus incision and drainage. 120 mg PO every 12 hours for 4 weeks. Omeprazole; Sodium Bicarbonate: (Major) Early reports noted an increase in the excretion of tetracyclines during coadministration with sodium bicarbonate, and that the oral absorption of tetracyclines is reduced by sodium bicarbonate via increased gastric pH. When concurrent therapy is needed, stagger administration times by several hours to minimize the potential for interaction, and monitor for antimicrobial efficacy. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. 120 mg PO every 12 hours until afebrile for at least 3 days and clinical improvement; 240 mg PO as a single dose may be effective in halting outbreaks, although some patients may relapse. Coadministration may impair absorption of doxycycline which may decrease its efficacy. 4.4 mg/kg/day IV on day 1, then 2.2 mg/kg/dose IV every 12 hours for at least 14 days or until clinical criteria for stability are met plus a bactericidal antimicrobial (e.g., ciprofloxacin). Further available data indicate that after doses of 100 to 200 mg PO, milk concentrations do not exceed an average of 1.8 mg/L. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. Halobetasol; Tazarotene: (Moderate) The manufacturer states that tazarotene should be administered with caution in patients who are also taking drugs known to be photosensitizers, such as tetracyclines, as concomitant use may augment phototoxicity. The risk of serious infection after tularemia exposure supports the use of doxycycline if antibiotic susceptibility testing, exhaustion of drug supplies, or allergic reactions preclude the use of streptomycin/gentamicin. [55918], 100 mg PO every 12 hours for at least 5 days as monotherapy for outpatients without comorbidities or risk factors for MRSA or P. aeruginosa or as part of combination therapy for outpatients with comorbidities or hospitalized patients with nonsevere pneumonia who have contraindications to or clinical failure with standard therapies. When concurrent therapy is needed, stagger administration times by several hours to minimize the potential for interaction, and monitor for antimicrobial efficacy. 2.6 mg/kg/dose (Max: 120 mg/dose) PO every 12 hours for 10 to 14 days as an alternative therapy. 2.2 mg/kg/dose (Max: 100 mg/dose) PO every 12 hours until 48 hours after the last perceived exposure as first-line therapy. To administer, bend the cannula to resemble a periodontal probe and explore the periodontal pocket in a manner similar to periodontal probing. are defined as susceptible at 4 mcg/mL or less, intermediate at 8 mcg/mL, and resistant at 16 mcg/mL or more. Bacterostatic antibacterials like tetracyclines may antagonize the bactericidal effects of penicillins which may reduce their efficacy. Guidelines suggest doxycycline may be used for the treatment of uncomplicated malaria in children younger than 8 years in rare instances if other options are not available or are not tolerated and benefit of use outweighs risks. Since blurred vision, diplopia, and permanent vision loss are potential clinical manifestations of intracranial hypertension, ophthalmologic evaluations (i.e., fundoscopy) are advised for patients developing visual symptoms while receiving doxycycline. Hydantoins decrease the half-life of doxycycline. It is not intended to be a substitute for the exercise of professional judgment. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available. 200 mg PO on day 1, then 100 mg PO once daily for 7 days. Nafcillin: (Minor) Consider additional monitoring or alternative antimicrobial therapy for patients with infections in which clinical response is highly dependent upon the rapid, bactericidal activity of penicillins. The clinical relevance of this interaction is poorly defined and for many infections the benefits of combination therapy are likely to outweigh the potential risks.
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