Usual Adult Dose for Acne

500 mg orally twice a day for 2 weeks or more, depending on the nature and severity of the infection

Usual Adult Dose for Bronchitis

500 mg orally every 6 hours for 7 to 10 days, depending on the nature and severity of the infection; may be given for 4 to 5 days a week during winter months as prophylaxis against chronic infectious bronchitis

Usual Adult Dose for Brucellosis

500 mg orally 4 times a day for 3 weeks given with streptomycin 1 g IM twice a day the first week and once a day the second week

Usual Adult Dose for Chlamydia Infection

Uncomplicated urethral, endocervical, or rectal infection: 500 mg orally 4 times a day for at least 7 days

The patient's sexual partner(s) should also be evaluated/treated.

Oral doxycycline therapy is preferred by the Centers for Disease Control and Prevention (CDC) for the treatment of chlamydial infections in nonpregnant patients.

Usual Adult Dose for Helicobacter pylori Infection

500 mg orally every 6 hours for 14 days given in conjunction with bismuth, metronidazole, and an H2 blocker

Usual Adult Dose for Lyme Disease - Arthritis

500 mg orally every 6 hours for 14 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Lyme Disease - Carditis

500 mg orally every 6 hours for 14 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

500 mg orally every 6 hours for 10 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Lyme Disease - Neurologic

500 mg orally every 6 hours for 21 to 30 days, depending on the nature and severity of the infection

Usual Adult Dose for Pneumonia

500 mg orally every 6 hours for 10 to 21 days, depending on the nature and severity of the infection

Usual Adult Dose for Rickettsial Infection

500 mg orally every 6 hours for 7 days

Usual Adult Dose for Upper Respiratory Tract Infection

500 mg orally every 6 hours for 7 to 10 days, depending on the nature and severity of the infection

Usual Adult Dose for Psittacosis

500 mg orally 4 times a day; initial treatment with IV doxycycline may be necessary for seriously ill patients
Duration: Treatment should continue at least 10 to 14 days after fever subsides to prevent relapse

Usual Adult Dose for Ornithosis

500 mg orally 4 times a day; initial treatment with IV doxycycline may be necessary for seriously ill patients
Duration: Treatment should continue at least 10 to 14 days after fever subsides to prevent relapse

Usual Adult Dose for Syphilis - Early

500 mg orally every 6 hours for 14 days; alternatively, 30 to 40 g in divided doses over a period of 10 to 15 days has been recommended

Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Syphilis - Latent

500 mg orally every 6 hours for 28 days; alternatively, 30 to 40 g in divided doses over a period of 10 to 15 days has been recommended

Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Tertiary Syphilis

500 mg orally every 6 hours for 28 days

Tetracycline should be used only if penicillins are contraindicated.

Usual Adult Dose for Nongonococcal Urethritis

500 mg orally every 6 hours for 7 days

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Gonococcal Infection - Uncomplicated

500 mg orally 4 times a day for 7 days

The patient's sexual partner(s) should also be evaluated/treated.

Neisseria gonorrhoeae is insufficiently susceptible to tetracycline; therefore, tetracycline is not recommended by the CDC for the treatment of gonorrhea. Oral doxycycline therapy is the preferred treatment for possible concurrent chlamydial infection in nonpregnant patients.

Usual Adult Dose for Cystitis

500 mg orally every 6 hours for 3 to 7 days, depending on the nature and severity of the infection; recommended if no alternatives exist

Usual Adult Dose for Epididymitis - Sexually Transmitted

500 mg orally every 6 hours for 10 days

The patient's sexual partner(s) should also be evaluated/treated.

Doxycycline for 10 days, in conjunction with a single dose of a parenteral third-generation cephalosporin like ceftriaxone, has been specifically recommended by the CDC as primary treatment for sexually transmitted epididymitis. Tetracycline may be a reasonable substitute for doxycycline in this regimen.

Usual Adult Dose for Lymphogranuloma Venereum

Although tetracyclines in general may be useful for the treatment of lymphogranuloma venereum, doxycycline is much more commonly used and is specifically recommended by the CDC as primary therapy for this disease. Therefore, the use of tetracycline for the treatment of this patient with lymphogranuloma venereum is not recommended. Doxycycline may be an effective alternative.

Usual Adult Dose for Pelvic Inflammatory Disease

Although tetracyclines in general may be useful in combination with other agents for the treatment of pelvic inflammatory disease, doxycycline is much more commonly used and is specifically recommended by the CDC as a therapy for this disease. Therefore, the use of tetracycline for the treatment of this patient with pelvic inflammatory disease is not recommended. Doxycycline may be an effective alternative.

Usual Pediatric Dose for Bacterial Infection

Above 8 years of age: 25 to 50 mg/kg orally per day divided in 4 equal doses

Renal Dose Adjustments

Total dosage should be decreased by reduction of recommended individual doses and/or by extending time intervals between doses.

Some experts recommend:
CrCl 50 to 80 mL/min: Usual dose every 8 to 12 hours
CrCl 10 to 50 mL/min: Usual dose 12 to 24 hours
CrCl less than 10 mL/min: Usual dose every 24 hours

Liver Dose Adjustments

Data not available

Precautions

Tetracycline may induce photosensitivity in some individuals. Patients on tetracycline therapy should minimize exposure to direct sunlight and other sources of ultraviolet radiation, and to use sunscreens and other protection whenever prolonged exposure is unavoidable. Therapy should be discontinued at the first sign of skin erythema.

If renal impairment exists, even usual oral or parenteral doses may lead to excessive systemic accumulation of the drug and possible liver toxicity. Under such conditions, lower than usual total doses are indicated and, if therapy is prolonged, serum level determinations of the drug may be advisable.

Renal, hepatic, and hematopoietic function should be monitored periodically during prolonged therapy.

Decomposed tetracyclines may cause potentially fatal nephrotoxicity (Fanconi's syndrome); therefore, outdated or decomposed medications should be discarded.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following tetracycline therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Dialysis

Data not available

Other Comments

Therapy should be continued for at least 1 to 2 days after symptoms and fever have subsided.

In the treatment of streptococcal infections, a therapeutic dose of tetracycline should be given for at least 10 days.

Administration of tetracycline with food, particularly dairy products, significantly reduces absorption. Tetracycline should be administered 1 hour before or 2 hours after meals. Taking the medication with a full glass of water in an upright position will help prevent esophageal ulceration and gastrointestinal irritation.

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