From the Guidelines
Doxycycline is an effective treatment for various skin infections, including those caused by Staphylococcus aureus and Streptococcus species, and is commonly prescribed at 100 mg twice daily for 7-14 days. The most recent and highest quality study, published in 2018 1, recommends doxycycline as an oral antibiotic option for the management of MRSA skin and soft-tissue infections. Doxycycline belongs to the tetracycline class of antibiotics and works by inhibiting bacterial protein synthesis, preventing bacteria from growing and multiplying.
When taking doxycycline, patients should avoid dairy products, antacids, and iron supplements within 2 hours of dosing as these can reduce absorption 1. Sun protection is important as doxycycline can cause photosensitivity. Take the medication with food to reduce stomach upset, but not right before lying down to prevent esophageal irritation. The 2018 study 1 also suggests that doxycycline can be used in combination with other antibiotics, such as beta-lactams, to provide coverage for both streptococci and MRSA.
Some key points to consider when prescribing doxycycline for skin infections include:
- Dosage: 100 mg twice daily for 7-14 days
- Contraindications: hypersensitivity to doxycycline or other tetracyclines
- Interactions: avoid dairy products, antacids, and iron supplements within 2 hours of dosing
- Side effects: photosensitivity, esophageal irritation, stomach upset
- Combination therapy: can be used with other antibiotics, such as beta-lactams, to provide coverage for both streptococci and MRSA.
It's worth noting that the 2014 study 1 also recommends doxycycline as a treatment option for certain types of skin infections, including those caused by Aeromonas hydrophila and Vibrio vulnificus. However, the 2018 study 1 provides more recent and comprehensive guidance on the use of doxycycline for skin infections.
From the FDA Drug Label
Doxycycline is indicated for the treatment of the following infections: ... Granuloma inguinale caused by Calymmatobacterium granulomatis. Doxycycline is indicated for treatment of infections caused by the following gram-positive microorganisms when bacteriologic testing indicates appropriate susceptibility to the drug: Upper respiratory infections caused by Streptococcus pneumoniae (formerly Diplococcus pneumoniae) Anthrax due to Bacillus anthracis, including inhalational anthrax (post-exposure): to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis. When penicillin is contraindicated, doxycycline is an alternative drug in the treatment of the following infections: Uncomplicated gonorrhea caused by Neisseria gonorrhoeae. Syphilis caused by Treponema pallidum. Yaws caused by Treponema pertenue. Listeriosis due to Listeria monocytogenes. Vincent’s infection caused by Fusobacterium fusiforme. Actinomycosis caused by Actinomyces israelii. Infections caused by Clostridium species.
Doxycycline may cover certain types of skin infections, including:
- Granuloma inguinale caused by Calymmatobacterium granulomatis
- Anthrax due to Bacillus anthracis
- Yaws caused by Treponema pertenue
- Actinomycosis caused by Actinomyces israelii
- Infections caused by Clostridium species 2
From the Research
Skin Infections and Doxycycline
- Doxycycline is a synthetic tetracycline with a wide spectrum of activity, including anti-inflammatory properties, making it suitable for treating various skin conditions 3.
- It is commonly used in dermatology for noninfectious conditions, such as acne vulgaris and rosacea, due to its efficacy and safety profile 3, 4.
- Doxycycline has been shown to inhibit molecular pathways associated with certain skin diseases, including hair follicle diseases, granulomatous diseases, and vascular proliferation 3.
Effectiveness Against Specific Skin Infections
- For community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, doxycycline demonstrated significant kill against noninducible strains, but only bacteriostatic activity against inducible strains 5.
- In the treatment of acne vulgaris, doxycycline is a commonly prescribed antibiotic, with a long track record of effectiveness and safety 4.
- For cellulitis, trimethoprim-sulfamethoxazole and clindamycin are preferred empiric therapies, especially in areas with high prevalence of CA-MRSA infections 6.
Comparison with Other Antibiotics
- Doxycycline's activity against CA-MRSA is comparable to other antibiotics, such as clindamycin and linezolid, but daptomycin and vancomycin demonstrated the most significant kill against all strains tested 5.
- In dermatology, doxycycline is often chosen over other tetracyclines, like minocycline, due to its lower risk of rare but potentially serious adverse reactions 4.