Adox Pak 2 / 100

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This information should not be used to decide whether or not to take Adox Pak 2/100 or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to Adox Pak 2/100 (doxycycline tablets and capsules). This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Review Date: October 4, 2017

IV:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:
-The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
-With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
-When used in streptococcal infections, duration of therapy should be 10 days.

Uses:
-For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
-For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
-When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
-As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Most products: 100 mg orally or IV twice a day
-Alternatively, Doryx(R) MPC: 120 mg orally twice a day
Duration of therapy: 60 days

Comments:
-Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
-Oral therapy should be started as soon as possible.
-Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to Bacillus anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

US CDC Recommendations:
-IV: 200 mg IV initially then 100 mg IV every 12 hours
-Oral: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:
-When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
-Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: 60 days
-Naturally-acquired cases: 7 to 10 days

Comments:
-Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
-Recommended as an alternative IV protein synthesis inhibitor for systemic anthrax when meningitis has been excluded
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
-Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

IV:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections: 120 mg orally every 12 hours

Comments:
-The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of granuloma inguinale due to Klebsiella granulomatis

US CDC Recommendations: 100 mg orally twice a day
Duration of therapy: At least 3 weeks and until all lesions have completely healed

Comments:
-Recommended as an alternative regimen
-Another antibiotic (e.g., an aminoglycoside such as gentamicin) may be added if no improvement is observed after several days.
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Most products: 100 mg orally once a day
-Alternatively, Doryx(R) MPC: 120 mg orally once a day

Comments:
-Prophylaxis should start 1 to 2 days before travel to endemic area; should continue daily while in malarious areas and for 4 weeks after leaving such areas
-Prophylaxis with this drug should not exceed 4 months.

Use: For prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

US CDC Recommendations: 100 mg orally once a day

Comments:
-Recommended for prophylaxis in all areas
-Not recommended for use during pregnancy.
-Current guidelines should be consulted for additional information.

IDSA Recommendations: 100 mg orally twice a day

Comments:
-Recommended for chronic oral antimicrobial suppression for prosthetic joint infection; as a preferred regimen against oxacillin-resistant staphylococci and as an alternative regimen against Propionibacterium species

IDSA Recommendations: 100 mg orally twice a day

Duration of Therapy:
-Acrodermatitis chronica atrophicans: 21 days
-Cardiac disease: 14 to 21 days
-Erythema migrans: 10 to 21 days
-Lyme arthritis: 28 days

Comments:
-Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
-A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
-Current guidelines should be consulted for additional information.

US CDC Recommendations: 100 mg orally or IV every 12 hours
Duration of therapy: 14 days

Comments:
-With other agents, recommended as part of a parenteral regimen or as part of an IM/oral regimen; also recommended as part of an alternative parenteral regimen
-This drug may be switched from IV to oral administration 24 to 48 hours after clinical improvement to complete 14 days of therapy.
-Current guidelines should be consulted for additional information.

Some Experts Recommend:
-Sclerosing agent: Mix 500 mg of the powder for injection and 10 mL of lidocaine 1% in 50 mL of normal saline and inject into pleural space.

Comments:
-Clinical trials have reported use of doses ranging from 250 mg to 1 g.

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
-Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections: 120 mg orally every 12 hours

Comments:
-The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
-With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
-Coadministration with streptomycin recommended for brucellosis.

Uses:
-For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
-For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
-When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
-As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:
-Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
-Severe infections: 2 mg/kg orally or IV every 12 hours
Maximum dose: 200 mg/day

Comments:
-Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
-Current guidelines should be consulted for additional information.

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
-Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections: 120 mg orally every 12 hours

Comments:
-The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
-With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
-Coadministration with streptomycin recommended for brucellosis.

Uses:
-For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
-For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
-When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
-As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:
-Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
-Severe infections: 2 mg/kg orally or IV every 12 hours
Maximum dose: 200 mg/day

Comments:
-Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
-Current guidelines should be consulted for additional information.

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
-Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections: 120 mg orally every 12 hours

Comments:
-The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
-With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
-Coadministration with streptomycin recommended for brucellosis.

Uses:
-For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
-For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
-When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
-As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:
-Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
-Severe infections: 2 mg/kg orally or IV every 12 hours
Maximum dose: 200 mg/day

Comments:
-Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
-Current guidelines should be consulted for additional information.

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
-Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections: 120 mg orally every 12 hours

Comments:
-The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
-With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
-Coadministration with streptomycin recommended for brucellosis.

Uses:
-For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
-For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
-When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
-As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:
-Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
-Severe infections: 2 mg/kg orally or IV every 12 hours
Maximum dose: 200 mg/day

Comments:
-Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
-Current guidelines should be consulted for additional information.

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
-Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections: 120 mg orally every 12 hours

Comments:
-The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
-With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
-Coadministration with streptomycin recommended for brucellosis.

Uses:
-For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
-For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
-When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
-As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:
-Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
-Severe infections: 2 mg/kg orally or IV every 12 hours
Maximum dose: 200 mg/day

Comments:
-Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
-Current guidelines should be consulted for additional information.

Less than 45 kg:
-Most products: 2.2 mg/kg orally or IV twice a day
---Alternatively, Doryx(R) MPC: 2.6 mg/kg orally twice a day

At least 45 kg:
-Most products: 100 mg orally or IV twice a day
---Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 60 days

Comments:
-Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
-Oral therapy should be started as soon as possible.
-Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

AAP Recommendations:
Term neonate (younger than 1 month): 4.4 mg/kg orally or IV initially then 2.2 mg/kg orally or IV every 12 hours

Children 1 month or older:
IV:
-Less than 45 kg: 4.4 mg/kg IV initially then 2.2 mg/kg IV every 12 hours
-At least 45 kg: 200 mg IV initially then 100 mg IV every 12 hours

ORAL:
-Less than 45 kg: 2.2 mg/kg orally every 12 hours
-At least 45 kg: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days after exposure

Systemic/severe anthrax when meningitis has been excluded:
-Term neonate (younger than 1 month): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
-Children 1 month or older: At least 14 days or until patient is clinically stable (whichever is longer)
-Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:
-Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
-Naturally-acquired cases: 7 to 10 days

Follow-up for severe anthrax:
-Term neonate (younger than 1 month): To complete a regimen of at least 10 to 14 days
-Children 1 month or older: To complete a regimen of at least 14 days
-Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:
-Recommended for postexposure prophylaxis as a preferred oral drug in children 1 month or older and as an alternative oral drug for term neonates (younger than 1 month)
-Recommended as an alternative oral drug for the treatment of cutaneous anthrax without systemic involvement
-Recommended as an alternative protein synthesis inhibitor for the IV treatment of systemic/severe anthrax when meningitis has been excluded and for oral follow-up for severe anthrax
-Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
-Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-Current guidelines should be consulted for additional information.

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
-Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
-Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
---More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
-Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:
-Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
-Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
---More severe infections: 120 mg orally every 12 hours

Comments:
-The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Uses:
-For the treatment of granuloma inguinale due to K granulomatis
-For the treatment of lymphogranuloma venereum due to C trachomatis

AAP Recommendations:
8 years or older: 100 mg orally twice a day

Duration of Therapy:
-Granuloma inguinale: At least 3 weeks and until all lesions have completely healed
-Lymphogranuloma venereum: 21 days

Comments:
-Recommended as the drug of choice for granuloma inguinale; gentamicin may be added if no improvement is observed after several days.
-Recommended as the preferred therapy for lymphogranuloma venereum
-The patient's sexual partner(s) should also be evaluated/treated.
-Current guidelines should be consulted for additional information.

Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:
-Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
-Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:
-Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
-Maintenance dose: 100 to 200 mg/day IV

Comments:
-The maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
-Not the drug of choice for any type of staphylococcal infection

Use: For the treatment of skin and soft tissue infections due to S aureus when bacteriological testing shows suitable susceptibility to this drug

IDSA Recommendations:
8 years or older:
-Up to 45 kg: 2 mg/kg orally every 12 hours
-Greater than 45 kg: 100 mg orally twice a day

Comments:
-Recommended for purulent cellulitis (cellulitis associated with purulent drainage/exudate without a drainable abscess) due to methicillin-resistant S aureus
-Current guidelines should be consulted for additional information.

IDSA Recommendations:
8 years or older: 2 mg/kg orally twice a day
Maximum dose: 100 mg/dose

Duration of Therapy:
-Acrodermatitis chronica atrophicans: 21 days
-Cardiac disease: 14 to 21 days
-Erythema migrans: 10 to 21 days
-Lyme arthritis: 28 days

Comments:
-Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
-A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
-Current guidelines should be consulted for additional information.

IDSA Recommendations:
8 years or older: 2 to 4 mg/kg orally twice a day
Maximum dose: 200 mg/dose
Duration of therapy: 14 days (range: 10 to 28 days)

Comments:
-Recommended as the preferred regimen for the treatment of nervous system Lyme disease (including the following syndromes: meningitis, any neurologic syndrome with CSF pleocytosis, peripheral nerve [radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF])
-Recommended in early Lyme disease for patients intolerant of beta-lactam antibiotics with acute neurologic disease manifested by meningitis or radiculopathy
-Current guidelines should be consulted for additional information.

Most formulations: No adjustment recommended.
40 mg capsule formulation: May need to adjust dose; however, no specific guidelines have been suggested.

Data not available

Data not available

Comments:
-Dialysis does not alter the serum half-life of this drug.