What is the next step in management for a 70-year-old male with improved symptoms after incision and drainage (I&D), taking doxycycline (doxycycline)?

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Last updated: May 10, 2025 • View editorial policy

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From the Guidelines

The patient should continue with the current treatment plan, including doxycycline, and maintain the scheduled surgical follow-up appointment, as the minimal discharge and absence of fever indicate a positive response to treatment. The patient's symptoms have improved since the incision and drainage procedure on May 5, and the reevaluation on May 7 showed minimal discharge on the old packing, which are all positive signs. Doxycycline is an appropriate antibiotic choice for skin and soft tissue infections, providing good coverage against common pathogens, including Staphylococcus and Streptococcus species, as recommended by the Infectious Diseases Society of America 1.

The guidelines suggest that for outpatients with purulent cellulitis, empirical therapy for CA-MRSA is recommended pending culture results, and doxycycline is a suitable option 1. Since the patient is taking doxycycline and showing signs of improvement, it is reasonable to continue this treatment. The patient should be advised to monitor for any worsening symptoms, such as increased pain, redness, swelling, purulent discharge, or fever, which would warrant earlier medical attention.

Proper wound care should be maintained with clean, dry dressings changed as directed by healthcare providers until complete healing occurs. The complete course of antibiotics should be finished, even if symptoms continue to improve, to prevent recurrence or development of antibiotic resistance. As the patient is scheduled to follow up with surgery, it is essential to keep this appointment to ensure the wound is healing properly and to address any concerns or complications that may arise.

From the FDA Drug Label

Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours) followed by a maintenance dose of 100 mg/day

  • The patient is taking doxycycline for an unspecified infection, but the dosage is not provided.
  • Based on the information provided, it is not possible to determine if the patient is taking the correct dose of doxycycline.
  • The patient's symptoms have improved, and he denies any fever.
  • The patient is scheduled to follow-up with surgery.
  • No conclusion can be drawn about the patient's treatment with doxycycline without more information about the infection being treated and the dosage being administered 2

From the Research

Patient Presentation

  • A 70-year-old male presents for packing change from incision and drainage that occurred on May 5
  • He was reevaluated on May 7 and reports improved symptoms, denying any fever
  • Minimal discharge on old packing is observed, and he is taking doxycycline
  • He is scheduled to follow-up with surgery, with no packing to remove

Relevance of Doxycycline

  • Doxycycline is being used as an antibiotic for the patient, as seen in the study 3, which evaluated the potent antibacterial activity of D-PLEX100, an antibiotic-releasing drug that contains doxycycline
  • The study 4 also mentions doxycycline as an alternative perioperative antibiotic, given medication shortages impacting the global supply chain

Antibiotic Prophylaxis

  • The study 3 suggests that D-PLEX100 provides safe and effective prophylaxis activity against the most prevalent surgical site infection (SSI) pathogens, including doxycycline-susceptible and resistant bacteria
  • The study 5 discusses the idea of stopping antibiotics when better (SAWB), rather than completing pre-set antibiotic courses, to reduce unnecessary exposure to antibiotics and antimicrobial resistance (AMR)
  • However, the study 4 aims to retrospectively assess doxycycline's efficacy, safety, and role in preventing surgical site infections, indicating a need for more research on the use of doxycycline for surgical antibiotic prophylaxis 4

Patient Care

  • The patient's improved symptoms and minimal discharge on old packing suggest that the current treatment plan, including doxycycline, may be effective
  • However, the decision to continue or stop antibiotics should be based on evidence and guidelines, as well as shared decision-making and personalized advice, as suggested by the study 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Potent antibacterial activity in surgical wounds with local administration of D-PLEX100.

European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences, 2023

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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