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Doxycycline structure.svg
Doxycycline 3D ball.png
Clinical data
Pronunciation /ˌdɒksɪˈskln/
Trade names Doryx, Doxyhexal, Doxylin among others
AHFS/ Monograph
MedlinePlus a682063
License data
  • AU: D
  • US: D (Evidence of risk)
    Routes of
    By mouth, IV [1]
    ATC code
    Legal status
    Legal status
    • AU: S4 (Prescription only)
    • UK: POM (Prescription only)
    • US: ℞-only
    Pharmacokinetic data
    Bioavailability 100%
    Protein binding 90%
    Metabolism Liver
    Elimination half-life 15–25 hours
    Excretion Urine (40%)
    CAS Number
    PubChem CID
    ECHA InfoCard 100.008.429 Blue pencil.svg
    Chemical and physical data
    Formula C22H24N2O8
    Molar mass 444.43 g/mol g·mol−1
    3D model (JSmol)
     X mark.svgNYes check.svgY  (what is this?)    (verify)

    Doxycycline is an antibiotic that is used in the treatment of infections caused by bacteria and certain other parasites. [1] It is used to treat bacterial pneumonia, acne, chlamydia infections, early Lyme disease, cholera, and syphilis. [1] It is also used to prevent malaria and in combination with quinine, to treat malaria. [1] Doxycycline can be used either by mouth or by injection into a vein. [1]

    Antibiotic drug used in the treatment and prevention of bacterial infections

    An antibiotic is a type of antimicrobial substance active against bacteria and is the most important type of antibacterial agent for fighting bacterial infections. Antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs which inhibit viruses are termed antiviral drugs or antivirals rather than antibiotics.

    Bacteria A domain of prokaryotes – single celled organisms without a nucleus

    Bacteria are a type of biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a number of shapes, ranging from spheres to rods and spirals. Bacteria were among the first life forms to appear on Earth, and are present in most of its habitats. Bacteria inhabit soil, water, acidic hot springs, radioactive waste, and the deep portions of Earth's crust. Bacteria also live in symbiotic and parasitic relationships with plants and animals. Most bacteria have not been characterised, and only about half of the bacterial phyla have species that can be grown in the laboratory. The study of bacteria is known as bacteriology, a branch of microbiology.

    Pneumonia Infection of the lungs

    Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Typically symptoms include some combination of productive or dry cough, chest pain, fever, and trouble breathing. Severity is variable.


    Common side effects include diarrhea, nausea, vomiting, and an increased risk of a sunburn. [1] Use after the first trimester of pregnancy or in young children may result in permanent problems with the teeth including changes in their color. [1] Its use during breastfeeding is probably safe. [1] Doxycycline is a broad-spectrum antibiotic of the tetracycline class. [1] Like other agents of this class, it either slows or kills bacteria by inhibiting protein production. [1] [2] It kills malaria by targeting a plastid organelle, the apicoplast. [3] [4]

    Diarrhea Loose or liquid bowel movements

    Diarrhea is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

    Sunburn burning of the skin by the suns radiation

    Sunburn is a form of radiation burn that affects living tissue, such as skin, that results from an overexposure to ultraviolet (UV) radiation, commonly from the sun. Common symptoms in humans and other animals include red or reddish skin that is hot to the touch, pain, general fatigue, and mild dizziness. An excess of UV radiation can be life-threatening in extreme cases. Excessive UV radiation is the leading cause of primarily non-malignant skin tumors.

    Breastfeeding Known as nursing, is the feeding of babies and young children with milk from a womans breast

    Breastfeeding, also known as nursing, is the feeding of babies and young children with milk from a woman's breast. Health professionals recommend that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. During the first few weeks of life babies may nurse roughly every two to three hours and the duration of a feeding is usually ten to fifteen minutes on each breast. Older children feed less often. Mothers may pump milk so that it can be used later when breastfeeding is not possible. Breastfeeding has a number of benefits to both mother and baby, which infant formula lacks.

    Doxycycline was patented in 1957 and came into commercial use in 1967. [5] [6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. [7] Doxycycline is available as a generic medicine and is generally inexpensive. [1] [8] The wholesale cost in the developing world is between US$0.01 and US$0.04 per pill. [9] In the United States, ten days of treatment costs about US$14; however, some in 2014 were selling it for more than US$3.00–10.00 per pill. [1] [10] In 2016, it was the 110th most prescribed medication in the United States, with more than 6 million prescriptions. [11]

    A health system, also sometimes referred to as health care system or as healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.

    Medical use

    Generic 100 mg doxycycline capsules Doxycycline 100mg capsules.jpg
    Generic 100 mg doxycycline capsules
    Doxycycline package Doxycycline.jpg
    Doxycycline package

    In addition to the general indications for all members of the tetracycline antibiotics group, doxycycline is frequently used to treat Lyme disease, chronic prostatitis, sinusitis, pelvic inflammatory disease, [12] [13] acne, rosacea, [14] [15] and rickettsial infections. [16]

    Tetracycline antibiotics type of broad-spectrum antibiotic

    Tetracyclines are a group of broad-spectrum antibiotic compounds that have a common basic structure and are either isolated directly from several species of Streptomyces bacteria or produced semi-synthetically from those isolated compounds. Tetracycline molecules comprise a linear fused tetracyclic nucleus to which a variety of functional groups are attached. Tetracyclines are named for their four ("tetra-") hydrocarbon rings ("-cycl-") derivation ("-ine"). They are defined as a subclass of polyketides, having an octahydrotetracene-2-carboxamide skeleton and are known as derivatives of polycyclic naphthacene carboxamide. While all tetracyclines have a common structure, they differ from each other by the presence of chloride, methyl, and hydroxyl groups. These modifications do not change their broad antibacterial activity, but do affect pharmacological properties such as half-life and binding to proteins in serum.

    Lyme disease infectious disease caused by Borrelia bacteria, spread by ticks

    Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by a bacterium named Borrelia spread by ticks. The most common sign of infection is an expanding area of redness on the skin, known as erythema migrans, that appears at the site of the tick bite about a week after it occurred. The rash is typically neither itchy nor painful. Approximately 70–80% of infected people develop a rash. Other early symptoms may include fever, headache and tiredness. If untreated, symptoms may include loss of the ability to move one or both sides of the face, joint pains, severe headaches with neck stiffness, or heart palpitations, among others. Months to years later, repeated episodes of joint pain and swelling may occur. Occasionally, people develop shooting pains or tingling in their arms and legs. Despite appropriate treatment, about 10 to 20% of people develop joint pains, memory problems, and tiredness for at least six months.

    Prostatitis Human disease

    Prostatitis is inflammation of the prostate gland. Prostatitis is classified into acute, chronic, asymptomatic inflammatory prostatitis, and chronic pelvic pain syndrome.

    In Canada, in 2004, doxycycline was considered a first-line treatment for chlamydia and non-gonococcal urethritis and with cefixime for uncomplicated gonorrhea. [17]

    Nongonococcal urethritis (NGU) is an inflammation of the urethra that is not caused by gonorrheal infection.

    Cefixime chemical compound

    Cefixime is an antibiotic useful to treat a number of bacterial infections. This includes otitis media, strep throat, pneumonia, urinary tract infections, gonorrhea, and Lyme disease. For gonorrhea typically only one dose is required. In the United States it is a second line treatment to ceftriaxone for gonorrhea. It is taken by mouth.

    Gonorrhea sexually transmitted infection

    Gonorrhea, colloquially known as the clap, is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. Many of those infected have no symptoms. Men may have burning with urination, discharge from the penis, or testicular pain. Women may have burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain. Complications in women include pelvic inflammatory disease and in men include inflammation of the epididymis. If untreated, gonorrhea can spread to joints or heart valves.


    Moraxella catarrhalis , Brucella melitensis , Chlamydia pneumoniae , and Mycoplasma pneumoniae are generally susceptible to doxycycline, while some Haemophilus spp., Mycoplasma hominis , and Pseudomonas aeruginosa have developed resistance to varying degrees. [18]

    Moraxella catarrhalis is a fastidious, nonmotile, Gram-negative, aerobic, oxidase-positive diplococcus that can cause infections of the respiratory system, middle ear, eye, central nervous system, and joints of humans. It causes the infection of the host cell by sticking to the host cell using trimeric autotransporter adhesins.

    <i>Brucella melitensis</i> species of bacterium

    Brucella melitensis is a Gram-negative coccobacillus bacterium from the Brucellaceae family. The bacterium causes ovine brucellosis, along with Brucella ovis. It can infect sheep, cattle, and sometimes humans, and it can be transmitted by the stable fly. It is zoonotic, unlike B. ovis, causing Malta fever or localized brucellosis in humans.

    Mycoplasma pneumoniae is a very small bacterium in the class Mollicutes. It is a human pathogen that causes the disease mycoplasma pneumonia, a form of atypical bacterial pneumonia related to cold agglutinin disease. M. pneumoniae is characterized by the absence of a peptidoglycan cell wall and resulting resistance to many antibacterial agents. The persistence of M. pneumoniae infections even after treatment is associated with its ability to mimic host cell surface composition.

    It is used in the treatment and prophylaxis of anthrax and Leptospirosis. [19] It is also effective against Yersinia pestis (the infectious agent of bubonic plague), and is prescribed for the treatment of Lyme disease, [20] [21] [22] [23] ehrlichiosis, [24] [25] and Rocky Mountain spotted fever. [26]

    Doxycycline is indicated for treatment of: [26] [27]

    When bacteriologic testing indicates appropriate susceptibility to the drug, doxycycline may be used to treat these infections caused by Gram-negative bacteria: [26] [27]

    Some Gram-positive bacteria have developed resistance to doxycycline. Up to 44% of Streptococcus pyogenes and up to 74% of S. faecalis specimens have developed resistance to the tetracycline group of antibiotics. When bacteriologic testing indicates appropriate susceptibility to the drug, doxycycline may be used to treat these infections caused by Gram-positive bacteria: [26] [27]

    When penicillin is contraindicated, doxycycline can be used to treat: [26] [27]

    Doxycycline may also be used as adjunctive therapy for severe acne. [26] [27]

    The first-line treatment for brucellosis is a combination of doxycycline and streptomycin and the second-line is a combination of doxycycline and rifampicin (rifampin). [31]


    Doxycycline is active against the erythrocytic stages of Plasmodium falciparum but not against the gametocytes of Plasmodium falciparum. [32] It is used to prevent malaria. [33] It is not recommended alone for initial treatment of malaria, even when the parasite is doxycycline-sensitive, because the antimalarial effect of doxycycline is delayed. [34]

    The World Health Organization Guidelines states that the combination of doxycycline with either artesunate or quinine may be used for the treatment of uncomplicated malaria due to Plasmodium falciparum or following intravenous treatment of severe malaria. [35]


    Doxycycline kills the symbiotic Wolbachia bacteria in the reproductive tracts of parasitic filarial nematodes, making the nematodes sterile, and thus reducing transmission of diseases such as onchocerciasis and elephantiasis. [36] Field trials in 2005 showed an eight-week course of doxycycline almost completely eliminates the release of microfilariae. [37]

    Spectrum of susceptibility

    Doxycycline has been used successfully to treat sexually transmitted, respiratory, and ophthalmic infections. Representative pathogenic genera include Chlamydia, Streptococcus, Ureaplasma, Mycoplasma, and others. The following represents MIC susceptibility data for a few medically significant microorganisms. [38]

    Adverse effects

    Adverse effects are similar to those of other members of the tetracycline antibiotic group. Doxycycline can cause gastrointestinal upset. [39] [40] Oral doxycycline can cause pill esophagitis, particularly when it is swallowed without adequate fluid, or by persons with difficulty swallowing or impaired mobility. [41] Doxycycline is less likely than other antibiotic drugs to cause Clostridium difficile colitis. [42]

    An erythematous rash in sun-exposed parts of the body has been reported to occur in 7.3–21.2% of persons taking doxycycline for malaria prophylaxis. One study examined the tolerability of various malaria prophylactic regimens and found doxycycline did not cause a significantly higher percentage of all skin events (photosensitivity not specified) when compared with other antimalarials. The rash resolves upon discontinuation of the drug. [43]

    Unlike some other members of the tetracycline group, it may be used in those with renal impairment. [44]


    The combination of doxycycline with dairy, antacids, calcium supplements, iron products, and laxatives containing magnesium is not inherently dangerous, but any of these foods and supplements may decrease doxycycline's effectiveness. [45]

    Breakfast was observed to reduce doxycycline absorption significantly. Absorption of tetracycline occurs in the stomach and the upper small intestine. Absorption of tetracyclines has been reported to be impaired by milk products, aluminum hydroxide gels, sodium bicarbonate, calcium and magnesium salts, laxatives containing magnesium and iron preparations. The mechanisms responsible for decreased absorption appear to be chelation and an increase in gastric pH. ... In view of these results, it is advisable to instruct the patients to take doxycycline on an empty stomach. [46]

    Previously, doxycycline was believed to impair the effectiveness of many types of hormonal contraception due to CYP450 induction. Recent research has shown no significant loss of effectiveness in oral contraceptives while using most tetracycline antibiotics (including doxycycline), although many physicians still recommend the use of barrier contraception for people taking the drug to prevent unwanted pregnancy. [47] [48] [49]

    Pregnancy and lactation

    Doxycycline is categorized by the FDA as a class D drug in pregnancy. Doxycycline crosses into breastmilk. [50] Other tetracycline antibiotics are contraindicated in pregnancy and up to eight years of age, due to the potential for disrupting bone and tooth development. [51] They include a class warning about staining of teeth and decreased development of dental enamel in children exposed to tetracyclines in utero, during breastfeeding or during young childhood. [52] However, the FDA has acknowledged that the actual risk of dental staining of primary teeth is undetermined for doxycycline specifically. The best available evidence indicates that doxycycline has little or no effect on hypoplasia of dental enamel or on staining of teeth and the CDC recommends the use of doxycycline for treatment of Q fever and also for tick-borne rickettsial diseases in young children and others advocate for its use in malaria. [53]


    Doxycycline, like other tetracycline antibiotics, is bacteriostatic. It works by preventing bacteria from reproducing through the inhibition of protein synthesis. [54]

    Doxycycline is highly lipophilic so can easily enter cells, meaning the drug is easily absorbed after oral administration and has a large volume of distribution. It can also be re-absorbed in the renal tubules and gastrointestinal tract due to its high lipophillicity so has a long elimination half life, and does not accumulate in the kidneys of patients with renal failure due to the compensatory excretion in faeces. [55] [56] Doxycycline–metal ion complexes are unstable at acid pH, therefore more doxycycline enters the duodenum for absorption than the earlier tetracycline compounds. In addition, food has less effect on absorption than on absorption of earlier drugs with doxycycline serum concentrations being reduced by about 20% by test meals compared with 50% for tetracycline. [57]

    Mechanism of action

    Doxycycline is a broad spectrum antibiotic, it inhibits the synthesis of bacterial proteins by binding to the 30S ribosomal subunit, which is only found in bacteria. [58] [59] This prevents the binding of transfer RNA to messenger RNA at the ribosomal subunit meaning amino acids cannot be added to polypeptide chains and new proteins cannot be made. This stops bacterial growth giving the immune system time to kill and remove the bacteria. [60]


    Expired tetracyclines or tetracyclines allowed to stand at a pH less than 2 are reported to be nephrotoxic due to the formation of a degradation product, anhydro-4-epitetracycline [61] [62] causing Fanconi syndrome. [63] In the case of doxycycline, the absence of a hydroxyl group in C-6 prevents the formation of the nephrotoxic compound. [62] Nevertheless, tetracyclines and doxycycline itself have to be taken with caution in patients with kidney injury, as they can worsen azotemia due to catabolic effects. [63]


    After penicillin revolutionized the treatment of bacterial infections in WWII, many chemical companies moved into the field of discovering antibiotics by bioprospecting. American Cyanamid was one of these, and in the late 1940s chemists there discovered chlortetracycline, the first member of the tetracycline class of antibiotics. [64] Shortly thereafter, scientists at Pfizer discovered terramycin and it was brought to market. Both compounds, like penicillin, were natural products and it was commonly believed that nature had perfected them, and further chemical changes could only degrade their effectiveness. Scientists at Pfizer led by Lloyd Conover modified these compounds, which led to the invention of tetracycline itself, the first semi-synthetic antibiotic. Charlie Stephens' group at Pfizer worked on further analogs and created one with greatly improved stability and pharmacological efficacy: doxycycline. It was clinically developed in the early 1960s and approved by the FDA in 1967. [64]

    As its patent grew near to expiring in the early 1970s, the patent became the subject of lawsuit between Pfizer and International Rectifier [65] that wasn't resolved until 1983; at the time it was the largest litigated patent case in US history. [66] Instead of a cash payment for infringement, Pfizer took the veterinary and feed-additive businesses of International Rectifier's subsidiary, Rachelle Laboratories. [66]

    In January 2013, the FDA reported shortages of some, but not all, forms of doxycyline "caused by increased demand and manufacturing issues". [67] Companies involved included an unnamed major generics manufacturer that ceased production in February 2013, Teva (which ceased production in May 2013), Mylan, Actavis, and Hikma Pharmaceuticals. [68] [69] The shortage came at a particularly bad time, since there were also shortages of an alternative antibiotic, tetracycline, at the same time. [70] The market price for doxycycline dramatically increased in the United States in 2013 and early 2014 (from $20 to over $1800 for a bottle of 500 tablets), [71] [72] [73] before decreasing again. [74] [75]

    Society and culture

    Doxycycline is available worldwide under many brand names. [76] Doxycycline is available as a generic medicine and is generally inexpensive. [1] [8] The wholesale cost is between US$0.01 and $0.04 per pill. [9]


    Tet-ON inducible shRNA system Tet-ON inducible transgene expression cells.svg
    Tet-ON inducible shRNA system

    At subantimicrobial doses, doxycycline is an inhibitor of matrix metalloproteases, and has been used in various experimental systems for this purpose, such as for recalcitrant recurrent corneal erosions. [77]

    Doxycycline has been used successfully in the treatment of one patient with lymphangioleiomyomatosis, an otherwise progressive and fatal disease. [78] It has also been shown to attenuate cardiac hypertrophy (in mice), a deadly consequence of prolonged hypertension. [79] In chronic obstructive pulmonary disease, doxycycline has been shown to improve lung functions in patients with stable symptoms. [80]

    Doxycycline is also used in "tet-on" (gene expression activated by doxycycline) and "tet-off" (gene expression inactivated by doxycycline) tetracycline-controlled transcriptional activation to regulate transgene expression in organisms and cell cultures. [81] Doxycycline is more stable than tetracycline for this purpose. [81]

    Other experimental applications include:

    Research reagent

    Doxycycline and other members of the tetracycline class of antibiotics are often used as research reagents in in vitro and in vivo biomedical research experiments involving bacteria as well in experiments in eukaryotic cells and organisms with inducible protein expression systems using tetracycline-controlled transcriptional activation. The mechanism of action for the antibacterial effect of tetracyclines relies on disrupting protein translation in bacteria, thereby damaging the ability of microbes to grow and repair; however protein translation is also disrupted in eukaryotic mitochondria impairing metabolism and leading to effects that can confound experimental results. [92] [93] Doxycycline may have anticancer activity. [94]

    Related Research Articles

    Amoxicillin antibiotic useful for the treatment of a number of bacterial infections

    Amoxicillin is an antibiotic often used for the treatment of a number of bacterial infections. These include middle ear infection, strep throat, pneumonia, skin infections, and urinary tract infections among others. It is taken by mouth, or less commonly by injection.

    Pelvic inflammatory disease infection of uterus, fallopian tubes, ovaries or the inner surface of pelvis

    Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

    Clarithromycin chemical compound

    Clarithromycin, sold under the brand name Biaxin among others, is an antibiotic used to treat various bacterial infections. This includes strep throat, pneumonia, skin infections, H. pylori infection, and Lyme disease, among others. Clarithromycin can be taken by mouth as a pill or liquid.

    Minocycline chemical compound

    Minocycline, sold under the brand name Minocin among others, is a tetracycline antibiotic used to treat a number of bacterial infections such as pneumonia. It is generally less preferred than the tetracycline doxycycline. It is also used for the treatment of acne and rheumatoid arthritis. It is taken by mouth.

    Atypical pneumonia, also known as walking pneumonia, is the type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it. When it develops independently from another disease it is called primary atypical pneumonia (PAP).

    <i>Chlamydia trachomatis</i> species of bacterium

    Chlamydia trachomatis, commonly known as chlamydia, is a bacterium that can replicate only in human cells. It causes chlamydia, which can manifest in various ways, including: trachoma, lymphogranuloma venereum, nongonococcal urethritis, cervicitis, salpingitis, pelvic inflammatory disease. C. trachomatis is the most common infectious cause of blindness and the most common sexually transmitted bacterium.

    Oxytetracycline second of the broad-spectrum tetracycline group of antibiotics to be discovered

    Oxytetracycline was the second of the broad-spectrum tetracycline group of antibiotics to be discovered.

    Azithromycin chemical compound

    Azithromycin is an antibiotic used for the treatment of a number of bacterial infections. This includes middle ear infections, strep throat, pneumonia, traveler's diarrhea, and certain other intestinal infections. It may also be used for a number of sexually transmitted infections, including chlamydia and gonorrhea infections. Along with other medications, it may also be used for malaria. It can be taken by mouth or intravenously with doses once per day.

    Lower respiratory tract infection

    Lower respiratory tract infection (LRTI), while often used as a synonym for pneumonia, can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue.

    <i>Chlamydophila pneumoniae</i> species of obligate intracellular bacterium

    Chlamydophila pneumoniae is a species of Chlamydophila, an obligate intracellular bacterium that infects humans and is a major cause of pneumonia. It was known as the Taiwan acute respiratory agent (TWAR) from the names of the two original isolates – Taiwan (TW-183) and an acute respiratory isolate designated AR-39. Until recently, it was known as Chlamydia pneumoniae, and that name is used as an alternate in some sources. In some cases, to avoid confusion, both names are given.

    Tigecycline chemical compound

    Tigecycline is an antibiotic for a number of bacterial infections. It is a glycylcycline administered intravenously. It was developed in response to the growing rate of antibiotic resistant bacteria such as Staphylococcus aureus, Acinetobacter baumannii, and E. coli. As a tetracycline derivative antibiotic, its structural modifications has expanded its therapeutic activity to include Gram-positive and Gram-negative organisms, including those of multi-drug resistance.

    Cefotaxime chemical compound

    Cefotaxime is an antibiotic used to treat a number of bacterial infections. Specifically it is used to treat joint infections, pelvic inflammatory disease, meningitis, pneumonia, urinary tract infections, sepsis, gonorrhea, and cellulitis. It is given either by injection into a vein or muscle.

    Gemifloxacin chemical compound

    Gemifloxacin mesylate is an oral broad-spectrum quinolone antibacterial agent used in the treatment of acute bacterial exacerbation of chronic bronchitis and mild-to-moderate pneumonia. Vansen Pharma Inc. has licensed the active ingredient from LG Life Sciences of Korea.

    Acute exacerbation of chronic obstructive pulmonary disease

    Acute exacerbation of COPD is a sudden worsening of COPD symptoms that typically lasts for several days. It may be triggered by an infection with bacteria or viruses or by environmental pollutants. Typically, infections cause 75% or more of the exacerbations; bacteria can roughly be found in 25% of cases, viruses in another 25%, and both viruses and bacteria in another 25%. Airway inflammation is increased during the exacerbation resulting in increased hyperinflation, reduced expiratory air flow and decreased gas exchange.

    Tubal factor infertility

    Tubal factor infertility (TFI) is female infertility caused by diseases, obstructions, damage, scarring, congenital malformations or other factors which impede the descent of a fertilized or unfertilized ovum into the uterus through the Fallopian tubes and prevents a normal pregnancy and full term birth. Tubal factors cause 25-30% of infertility cases. Tubal factor is one complication of Chlamydia trachomatis infection in women.


    1. 1 2 3 4 5 6 7 8 9 10 11 12 13 "Doxycycline calcium". The American Society of Health-System Pharmacists. Archived from the original on 23 September 2015. Retrieved 18 August 2015.
    2. Nelson, ML; Levy, SB (December 2011). "The history of the tetracyclines". Annals of the New York Academy of Sciences. 1241 (1): 17–32. Bibcode:2011NYASA1241...17N. doi:10.1111/j.1749-6632.2011.06354.x. PMID   22191524.
    3. McFadden GI (March 2014). "Apicoplast". Curr. Biol. 24 (7): R262–3. doi:10.1016/j.cub.2014.01.024. PMID   24698369.
    4. Schlagenhauf-Lawlor, Patricia (2008). Travelers' Malaria. PMPH-USA. p. 148. ISBN   9781550093360.
    5. Fischer, Janos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 489. ISBN   9783527607495.
    6. Corey, E.J. (2013). Drug discovery practices, processes, and perspectives. Hoboken, N.J.: John Wiley & Sons. p. 406. ISBN   9781118354469.
    7. "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
    8. 1 2 Hamilton, Richard J. (2011). Tarascon pharmacopoeia (2011 library ed., 2011 ed., 12th ed.). Sudbury, MA: Jones & Bartlett Learning. p. 79. ISBN   9781449600679.
    9. 1 2 "Doxycycline". International Medical Products Price Guide. Retrieved 16 January 2018.
    10. "Officials Question the Rising Costs of Generic Drugs". New York Times. 7 October 2014. Archived from the original on 28 October 2015. Retrieved 22 September 2015.
    11. "The Top 300 of 2019". Retrieved 22 December 2018.
    12. Sweet RL, Schachter J, Landers DV, Ohm-Smith M, Robbie MO (1988). "Treatment of hospitalized patients with acute pelvic inflammatory disease: comparison of cefotetan plus doxycycline and ana doxycycline". Am. J. Obstet. Gynecol. 158 (3 Pt 2): 736–41. doi:10.1016/S0002-9378(16)44537-0. PMID   3162653.
    13. Gjønnaess H, Holten E (1978). "Doxycycline (Vibramycin) in pelvic inflammatory disease". Acta Obstet Gynecol Scand. 57 (2): 137–9. doi:10.3109/00016347809155893. PMID   345730.
    14. Määttä M; Kari O; Tervahartiala T; et al. (2006). "Tear fluid levels of MMP-8 are elevated in ocular rosacea—treatment effect of oral doxycycline". Graefes Arch. Clin. Exp. Ophthalmol. 244 (8): 957–62. doi:10.1007/s00417-005-0212-3. PMID   16411105.
    15. Quarterman MJ, Johnson DW, Abele DC, Lesher JL, Hull DS, Davis LS (1997). "Ocular rosacea. Signs, symptoms, and tear studies before and after treatment with doxycycline". Arch Dermatol. 133 (1): 49–54. doi:10.1001/archderm.133.1.49. PMID   9006372.
    16. Walker DH, Paddock CD, Dumler JS (November 2008). "Emerging and re-emerging tick-transmitted rickettsial and ehrlichial infections". Med. Clin. North Am. 92 (6): 1345–61, x. doi:10.1016/j.mcna.2008.06.002. PMID   19061755.
    17. Michael L. Rekart, MD, DTM&H, MHSc (December 2014). "Doxycycline: "New" treatment of choice for genital chlamydia infections". Archived from the original on 2 February 2017.CS1 maint: Multiple names: authors list (link)
    18. "Doxycycline spectrum of bacterial susceptibility and Resistance" (PDF). Archived from the original (PDF) on 1 February 2014. Retrieved 4 May 2012.
    19. Stoddard, Robyn A.; Galloway, Renee L.; Guerra, Marta A. (10 July 2015). "Leptospirosis - Chapter 3". Atlanta, GA: Centers for Disease Control and Prevention. Archived from the original on 9 April 2017. Retrieved 16 April 2017.
    20. Nadelman RB, Luger SW, Frank E, Wisniewski M, Collins JJ, Wormser GP (1992). "Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease". Annals of Internal Medicine. 117 (4): 273–80. doi:10.7326/0003-4819-117-4-273. PMID   1637021.
    21. Luger SW; Paparone P; Wormser GP; et al. (March 1995). "Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans". Antimicrob. Agents Chemother. 39 (3): 661–7. doi:10.1128/AAC.39.3.661. PMC   162601 . PMID   7793869.
    22. Nadelman RB; Nowakowski J; Fish D; et al. (2001). "Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite". N. Engl. J. Med. 345 (2): 79–84. doi:10.1056/NEJM200107123450201. PMID   11450675. Archived from the original on 5 January 2008.
    23. Karlsson M, Hammers-Berggren S, Lindquist L, Stiernstedt G, Svenungsson B (1994). "Comparison of intravenous penicillin G and oral doxycycline for treatment of Lyme neuroborreliosis". Neurology. 44 (7): 1203–7. doi:10.1212/WNL.44.7.1203. PMID   8035916.
    24. Weinstein RS (1996). "Human ehrlichiosis". Am Fam Physician. 54 (6): 1971–6. PMID   8900357.
    25. Karlsson U, Bjöersdorff A, Massung RF, Christensson B (2001). "Human granulocytic ehrlichiosis—a clinical case in Scandinavia". Scand. J. Infect. Dis. 33 (1): 73–4. doi:10.1080/003655401750064130. PMID   11234985.
    26. 1 2 3 4 5 6 U.S. Food and Drug Administration. 14 December 2012. Doxycycline, ANDA no. 065055 Label. Archived 19 April 2014 at the Wayback Machine
    27. 1 2 3 4 5 U.S. Food and Drug Administration. 16 July 2008.Doxycycline, ANDA no. 065454 Label Archived 19 October 2013 at the Wayback Machine
    28. Anderson A, Bijlmer H, Fournier PE, Graves S, Hartzell J, Kersh GJ, Limonard G, Marrie TJ, Massung RF, McQuiston JH, Nicholson WL, Paddock CD, Sexton DJ (2013). "Diagnosis and management of Q fever—United States, 2013: recommendations from CDC and the Q Fever Working Group". MMWR Recomm. Rep. 62 (RR-03): 1–30. PMID   23535757. Archived from the original on 19 April 2014.
    29. Okada T, Morozumi M, Tajima T, Hasegawa M, Sakata H, Ohnari S, Chiba N, Iwata S, Ubukata K (2012). "Rapid effectiveness of minocycline or doxycycline against macrolide-resistant Mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children". Clin Infect Dis. 55 (12): 1642–9. doi:10.1093/cid/cis784. PMID   22972867.
    30. "Lyme disease. Treatment". 21 December 2018. Archived from the original on 10 June 2016.
    31. William Cameron. "Comparison of doxycycline–streptomycin, doxycycline–rifampin, and ofloxacin–rifampin in the treatment of brucellosis: a randomized clinical trial" . Retrieved 23 August 2014.
    33. "Malaria - Chapter 3 - 2018 Yellow Book | Travelers' Health | CDC". CDC. Retrieved 4 December 2018.
    34. Dahl EL, Shock JL, Shenai BR, Gut J, DeRisi JL, Rosenthal PJ (2006). "Tetracyclines specifically target the apicoplast of the malaria parasite Plasmodium falciparum". Antimicrob. Agents Chemother. 50 (9): 3124–31. doi:10.1128/AAC.00394-06. PMC   1563505 . PMID   16940111.
    35. Guidelines for the treatment of malaria. Geneva: World Health Organization. 2015. p. 246. ISBN   978-92-4-154912-7.
    36. Hoerauf A, Mand S, Fischer K, et al. (2003). "Doxycycline as a novel strategy against bancroftian filariasis-depletion of Wolbachia endosymbionts from Wuchereria bancrofti and stop of microfilaria production". Med. Microbiol. Immunol. 192 (4): 211–6. doi:10.1007/s00430-002-0174-6. PMID   12684759.
    37. Taylor MJ, Makunde WH, McGarry HF, Turner JD, Mand S, Hoerauf A (2005). "Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial". Lancet. 365 (9477): 2116–21. doi:10.1016/S0140-6736(05)66591-9. PMID   15964448.
    38. "Doxycycline hyclate Susceptibility and Minimum Inhibitory Concentration (MIC) Data" (PDF). Retrieved April 16, 2017.
    39. Hitchings, Andrew; Lonsdale, Dagan; Burrage, Daniel; Baker, Emma (2015). Top 100 drugs : clinical pharmacology and practical prescribing. pp. 200–201. ISBN   978-0-7020-5516-4.
    40. Riond, JL; Riviere, JE (October 1988). "Pharmacology and toxicology of doxycycline". Veterinary and Human Toxicology. 30 (5): 431–43. PMID   3055652.
    41. Affolter K, Samowitz W, Boynton K, Kelly ED (August 2017). "Doxycycline-induced gastrointestinal injury". Hum. Pathol. 66: 212–215. doi:10.1016/j.humpath.2017.02.011. PMID   28286288.
    42. Hung YP, Lee JC, Lin HJ, Liu HC, Wu YH, Tsai PJ, Ko WC (June 2015). "Doxycycline and Tigecycline: Two Friendly Drugs with a Low Association with Clostridium Difficile Infection". Antibiotics (Basel). 4 (2): 216–29. doi:10.3390/antibiotics4020216. PMC   4790331 . PMID   27025622.
    43. Center for Global Health, Centers for Disease Control and Prevention (2011). "Doxycycline for Malaria Chemoprophylaxis and Treatment: Report from the CDC Expert Meeting on Malaria Chemoprophylaxis". The American Journal of Tropical Medicine and Hygiene. 84 (4): 517–531. doi:10.4269/ajtmh.2011.10-0285. PMC   3062442 . PMID   21460003. Archived from the original on 5 July 2012. Retrieved 17 May 2012.[ verification needed ]
    44. Center for Drug Evaluation and Research (November–December 2004). "European recommendations on the use of oral antibiotics for acne". European Journal of Dermatology. 14 (6): 391–399. Archived from the original on 29 May 2007. Retrieved 31 January 2008.[ verification needed ]
    45. PubMed Health (1 July 2016). "Doxycycline (By mouth)". U.S. National Library of Medicine. Archived from the original on 11 November 2013. Retrieved 16 July 2016.
    46. Kshirsagar N A, Ankalesaria P S. Effect of food on doxycycline absorption. J Postgrad Med (serial online) 1987 (cited 2016 Jul 16);33:117. Available from: Archived 18 August 2016 at the Wayback Machine
    47. Archer JS, Archer DF (2002). "Oral contraceptive efficacy and antibiotic interaction: a myth debunked". J. Am. Acad. Dermatol. 46 (6): 917–23. doi:10.1067/mjd.2002.120448. PMID   12063491.
    48. Dréno B, Bettoli V, Ochsendorf F, Layton A, Mobacken H, Degreef H (November–December 2004). "European recommendations on the use of oral antibiotics for acne" (PDF). Eur J Dermatol. 14 (6): 391–9. PMID   15564203.[ permanent dead link ]
    49. DeRossi SS, Hersh EV (2002). "Antibiotics and oral contraceptives". Dent. Clin. North Am. 46 (4): 653–64. CiteSeerX . doi:10.1016/S0011-8532(02)00017-4. PMID   12436822.
    50. Chung, AM; Reed, MD; Blumer, JL (2002). "Antibiotics and breast-feeding: a critical review of the literature". Paediatric Drugs. 4 (12): 817–37. doi:10.2165/00128072-200204120-00006. PMID   12431134.
    51. Mylonas, I (January 2011). "Antibiotic chemotherapy during pregnancy and lactation period: aspects for consideration". Archives of Gynecology and Obstetrics. 283 (1): 7–18. doi:10.1007/s00404-010-1646-3. PMID   20814687.
    52. "Bioterrorism and Drug Preparedness - Doxycycline Use by Pregnant and Lactating Women". Retrieved 9 December 2018.
    53. Gaillard T, Briolant S, Madamet M, Pradines B (April 2017). "The end of a dogma: the safety of doxycycline use in young children for malaria treatment". Malar. J. 16 (1): 148. doi:10.1186/s12936-017-1797-9. PMC   5390373 . PMID   28407772.
    54. Flower, R.; Rang, H. P.; Dale, M. M.; Ritter, J. M.; Henderson, G. (2012). Rang & Dale's Pharmacology. Edinburgh: Churchill Livingstone. ISBN   978-0-7020-3471-8.
    55. Riond, JL; Riviere, JE (October 1988). "Pharmacology and toxicology of doxycycline". Veterinary and Human Toxicology. 30 (5): 431–43. PMID   3055652.
    56. Maaland, MG; Papich, MG; Turnidge, J; Guardabassi, L (November 2013). "Pharmacodynamics of doxycycline and tetracycline against Staphylococcus pseudintermedius: proposal of canine-specific breakpoints for doxycycline". Journal of Clinical Microbiology. 51 (11): 3547–54. doi:10.1128/JCM.01498-13. PMC   3889732 . PMID   23966509.
    57. Agwuh, KN; MacGowan, A (2006). "Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines". J. Antimicrob. Chemother. 58 (2): 256–265. doi:10.1093/jac/dkl224. PMID   16816396.
    58. Hitchings, Andrew; Lonsdale, Dagan; Burrage, Daniel; Baker, Emma (2015). Top 100 drugs : clinical pharmacology and practical prescribing. pp. 200–201. ISBN   978-0-7020-5516-4.
    59. Maaland, MG; Papich, MG; Turnidge, J; Guardabassi, L (November 2013). "Pharmacodynamics of doxycycline and tetracycline against Staphylococcus pseudintermedius: proposal of canine-specific breakpoints for doxycycline". Journal of Clinical Microbiology. 51 (11): 3547–54. doi:10.1128/JCM.01498-13. PMC   3889732 . PMID   23966509.
    60. "Doxycycline". Retrieved 23 January 2019.
    61. "Principles and methods for the assessment of nephrotoxicity associated with exposure to chemicals" Archived 10 May 2011 at the Wayback Machine . Environmental health criteria: 119. World Health Organization (WHO). ISBN   92-4-157119-5. ISSN   0250-863X. 1991.
    62. 1 2 Foye's Principles of Medicinal Chemistry; David A. Williams; William O. Foye, Thomas L. Lemke
    63. 1 2 Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12ed, Laurence L. Brunton, Bruce A. Chabner, Björn C. Knollmann
    64. 1 2 Nelson ML, Levy SB (Dec 2011). "The history of the tetracyclines". Ann N Y Acad Sci. 1241 (1): 17–32. Bibcode:2011NYASA1241...17N. doi:10.1111/j.1749-6632.2011.06354.x. PMID   22191524.
    65. Pfizer, Inc. v. International Rectifier Corp., 545 F. Supp. 486 (C.D. Cal. 1980) Archived 24 February 2015 at the Wayback Machine
    66. 1 2 The Associated Press, 6 July 1983 Pfizer to Get Rachelle Units Archived 6 March 2016 at the Wayback Machine The New York Times.
    67. CDC Health Alert Network 12 June 2013 Nationwide Shortage of Doxycycline: Resources for Providers and Recommendations for Patient Care Archived 15 February 2015 at the Wayback Machine
    68. American Society of Health-System Pharmacists. 12 December 2014 Doxycycline Capsules and Tablets Archived 1 January 2015 at the Wayback Machine
    69. American Society of Health-System Pharmacists. 12 November 2014 Doxycycline Hyclate Injection Archived 1 January 2015 at the Wayback Machine
    70. Consumer Reports News: 4 February 2013 FDA reports shortage of doxycycline antibiotic. What are your options? Archived 1 January 2015 at the Wayback Machine
    71. Sudden increase in cost of common drug concerns many Archived 31 December 2014 at the Wayback Machine , WSMV-TV, 12 March 2013 (updated 26 March 2013).
    72. Rosenthal, Elisabeth, Officials Question the Rising Costs of Generic Drugs Archived 23 February 2017 at the Wayback Machine , The New York Times , 7 October 2014.
    73. Eric Palmer for FiercePharmaManufacturing. 13 March 2014 Hikma hits the jackpot with doxycycline shortage Archived 1 January 2015 at the Wayback Machine
    74. "Costco Drug Information". Archived from the original on 4 March 2016. Retrieved 31 July 2016.
    75. "Doxycycline Hyclate Prices and Doxycycline Hyclate Coupons". GoodRx. Archived from the original on 28 July 2016. Retrieved 31 July 2016.
    76. international availability for doxycycline Archived 16 May 2015 at the Wayback Machine Page accessed April 29, 2015
    77. Dursun D, Kim MC, Solomon A, Pflugfelder SC (2001). "Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix metalloproteinase-9, doxycycline and corticosteroids". Am. J. Ophthalmol. 132 (1): 8–13. doi:10.1016/S0002-9394(01)00913-8. PMID   11438047.
    78. Moses MA, Harper J, Folkman J (2006). "Doxycycline treatment for lymphangioleiomyomatosis with urinary monitoring for MMPs". N. Engl. J. Med. 354 (24): 2621–2. doi:10.1056/NEJMc053410. PMID   16775248.
    79. Errami M, Galindo CL, Tassa AT, Dimaio JM, Hill JA, Garner HR (2007). "Doxycycline attenuates isoproterenol- and transverse aortic banding- induced cardiac hypertrophy in mice". J Pharmacol Exp Ther. 324 (3): 1196–203. doi:10.1124/jpet.107.133975. PMID   18089841.
    80. Dalvi PS; Singh A; Trivedi HR; et al. (2011). "Effect of doxycycline in patients of moderate to severe chronic obstructive pulmonary disease with stable symptoms". Ann Thorac Med. 6 (4): 221–6. doi:10.4103/1817-1737.84777. PMC   3183640 . PMID   21977068. Archived from the original on 22 March 2012.
    81. 1 2 Gossen M, Freundlieb S, Bender G, Müller G, Hillen W, Bujard H (1995). "Transcriptional activation by tetracyclines in mammalian cells". Science . 268 (5218): 1766–1769. Bibcode:1995Sci...268.1766G. doi:10.1126/science.7792603. PMID   7792603.
    82. Leung, E; Landa, G (September 2013). "Update on current and future novel therapies for dry age-related macular degeneration". Expert Review of Clinical Pharmacology. 6 (5): 565–79. doi:10.1586/17512433.2013.829645. PMID   23971874.
    83. Saraiva IH, Jones RN, Erwin M, Sader HS (1997). "[Evaluation of antimicrobial sensitivity of 87 clinical isolates of vancomycin-resistant enterococci]". Rev Assoc Med Bras (in Portuguese). 43 (3): 217–22. doi:10.1590/S0104-42301997000300009. PMID   9497549.
    84. Dibb WL, Digranes A (1981). "Characteristics of 20 human Pasteurella isolates from animal bite wounds". Acta Pathol Microbiol Scand [B]. 89 (3): 137–41. PMID   7315339.
    85. Greenwald RA (December 2011). "The road forward: the scientific basis for tetracycline treatment of arthritic disorders". Pharmacol. Res. 64 (6): 610–3. doi:10.1016/j.phrs.2011.06.010. PMID   21723947.
    86. Raza M, Ballering JG, Hayden JM, Robbins RA, Hoyt JC (2006). "Doxycycline decreases monocyte chemoattractant protein-1 in human lung epithelial cells". Exp. Lung Res. 32 (1–2): 15–26. doi:10.1080/01902140600691399. PMID   16809218.
    87. Chodosh S, Tuck J, Pizzuto D (1988). "Comparative trials of doxycycline versus amoxicillin, cephalexin and enoxacin in bacterial infections in chronic bronchitis and asthma". Scand J Infect Dis Suppl. 53: 22–8. PMID   3047855.
    88. Joks R, Durkin HG (December 2011). "Non-antibiotic properties of tetracyclines as anti-allergy and asthma drugs". Pharmacol. Res. 64 (6): 602–9. doi:10.1016/j.phrs.2011.04.001. PMID   21501686.
    89. Bachelez H, Senet P, Cadranel J, Kaoukhov A, Dubertret L (2001). "The use of tetracyclines for the treatment of sarcoidosis". Arch Dermatol. 137 (1): 69–73. doi:10.1001/archderm.137.1.69. PMID   11176663. Archived from the original on 7 April 2008.
    90. El Sayed F, Dhaybi R, Ammoury A (2006). "Subcutaneous nodular sarcoidosis and systemic involvement successfully treated with doxycycline". J Med Liban. 54 (1): 42–4. PMID   17044634.
    91. Mishra GP, Mulani JD. "Doxycycline: An Old Drug With A New Role In Idiopathic Pulmonary Fibrosis" Archived 23 July 2011 at the Wayback Machine . International Journal of Pharma and Bio Sciences. V1(2) 2010. ISSN   0975-6299.
    92. Moullan N, Mouchiroud L, Wang X, Ryu D, Williams EG, Mottis A, Jovaisaite V, Frochaux MV, Quiros PM, Deplancke B, Houtkooper RH, Auwerx J (2015). "Tetracyclines Disturb Mitochondrial Function across Eukaryotic Models: A Call for Caution in Biomedical Research". Cell Reports. 10 (10): 1681–91. doi:10.1016/j.celrep.2015.02.034. PMC   4565776 . PMID   25772356.
    93. Chatzispyrou IA, Held NM, Mouchiroud L, Auwerx J, Houtkooper RH (2015). "Tetracycline antibiotics impair mitochondrial function and its experimental use confounds research". Cancer Research. 75 (21): 4446–9. doi:10.1158/0008-5472.CAN-15-1626. PMC   4631686 . PMID   26475870.
    94. Ali, Isra; Alfarouk, Khalid Omer; Reshkin, Stephan Joel; Ibrahim, Muntaser Eltayeb (2017). "Doxycycline as Potential Anti-cancer Agent". Anti-Cancer Agents in Medicinal Chemistry. 17 (12): 1617–1623. doi:10.2174/1871520617666170213111951. PMID   28270076.