From the Guidelines
Doxycycline can be administered to children of all ages, including those under 8 years old, for the treatment of tickborne rickettsial diseases, as the benefits of treatment outweigh the risks of tooth staining or enamel hypoplasia 1.
Key Points
- The American Academy of Pediatrics and CDC recommend doxycycline as the treatment of choice for children of all ages with suspected tickborne rickettsial disease 1.
- Previous concerns about tooth staining in children under 8 years old are no longer considered a significant risk, as doxycycline has been shown to have a negligible effect on tooth color when used in short courses 1.
- The use of doxycycline in children under 8 years old is justified due to the life-threatening nature of tickborne rickettsial diseases and the favorable risk-benefit ratio of treatment 1.
- Some studies suggest that even multiple courses of doxycycline in children under 8 years old do not result in significant tooth staining or enamel hypoplasia 1.
Dosage
- The recommended dosage of doxycycline for children is 2.2 mg/kg per dose twice a day, with a maximum dose of 100 mg per dose 1.
- For children under 8 years old with mild or uncomplicated illness, a shorter duration of doxycycline (5 days) may be considered, while those with severe illness or high-risk criteria should receive the full 14-day treatment course 1.
From the FDA Drug Label
For children above eight years of age: The recommended dosage schedule for children weighing 100 pounds or less is 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days. For the prophylaxis of malaria: For children over 8 years of age, the recommended dose is 2 mg/kg given once daily up to the adult dose. Inhalational anthrax (post-exposure): CHILDREN: weighing less than 100 lb (45 kg); 1 mg/lb (2.2 mg/kg) of body weight, by mouth, twice a day for 60 days. Children weighing 100 lb or more should receive the adult dose.
The minimum age for doxycycline administration is 8 years 2.
From the Research
Minimum Age for Doxycycline Administration
The minimum age for doxycycline administration has been a topic of discussion due to concerns about tooth discoloration and dental enamel hypoplasia. However, recent studies have shown that doxycycline may be safe for use in children under 8 years of age.
- Studies have found little or no effects of doxycycline on tooth staining or dental enamel hypoplasia in children under 8 years of age 3, 4, 5.
- The Centers for Disease Control and Prevention have recommended the use of doxycycline for the treatment of acute and chronic Q fever and tick-borne rickettsial diseases in young children 3.
- Recommendations have changed to state that doxycycline, but not other tetracyclines, can be used for short courses (<21 days) regardless of age 4.
- A population pharmacokinetics study found that doxycycline clearance and volume of distribution did not differ between children 2 to ≤8 years of age and children >8 to ≤18 years of age, suggesting that younger children may be given the same per kg dosing 6.
- However, some studies still suggest that doxycycline should be used with caution in young children and pregnant or breastfeeding women, and that alternative antibiotics should be used whenever possible 7.