Should I continue doxycycline (doxycycline) treatment for my hand infection and swollen submandibular lymph nodes despite persistent fatigue and low energy?

Management of Persistent Hand Infection After Second Course of Doxycycline

You should complete your current course of doxycycline and follow up with your healthcare provider as your infection has not fully resolved despite appropriate treatment and adjunctive measures.

Current Situation Assessment

Your symptoms suggest a partially responding but persistent skin and soft tissue infection:

• Submandibular lymph node swelling (bilateral) that has decreased but not resolved
• Persistent central infection on the right hand with pain on pressure
• Fatigue without other systemic symptoms
• Appropriate use of prescribed treatments (doxycycline, Hibiclens washing, mupirocin application)

Treatment Recommendations

Complete Current Course

• Continue your current doxycycline regimen (100 mg twice daily) until completed as prescribed 1
• Continue local wound care with Hibiclens washing and mupirocin application
• Take doxycycline with a full glass of water and food to minimize gastrointestinal side effects 2
• Avoid lying down for at least 1 hour after taking doxycycline to prevent esophagitis 2

Follow-up Evaluation Needed

• Schedule a follow-up appointment within 72 hours if:
  • The central infection site continues to enlarge
  • Pain increases significantly
  • You develop fever, chills, or worsening fatigue
  • Red streaking appears from the wound

Rationale for Recommendation

The standard duration for skin and soft tissue infections with doxycycline is typically 7-14 days 1. Your persistent symptoms despite being on a second course suggest:

1. The infection may be partially resistant to doxycycline
2. There may be a localized abscess requiring drainage
3. The fatigue may be related to the ongoing inflammatory response

Addressing Your Specific Concerns

Persistent Lymphadenopathy

• Submandibular lymph node swelling that is decreasing in size is consistent with a responding but ongoing infection 3
• Bilateral involvement suggests a systemic inflammatory response to the infection

Fatigue Without Other Symptoms

• Fatigue is a common symptom during infection and inflammatory responses
• Doxycycline itself can occasionally cause fatigue as a side effect 1
• The absence of other symptoms (headache, sore throat, GI symptoms) is reassuring against systemic spread

Persistent Central Infection Site

• The enlarging central area with pain suggests possible abscess formation that may require incision and drainage
• The FDA drug information for doxycycline specifically notes: "Incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy, when indicated" 1

Common Pitfalls to Avoid

1. Premature discontinuation of antibiotics: Stopping antibiotics before completing the full course can lead to recurrence and antibiotic resistance 1

2. Failure to recognize need for surgical intervention: Some skin infections develop abscesses that require drainage despite appropriate antibiotic therapy 1

3. Attributing all symptoms to medication side effects: While doxycycline can cause fatigue, persistent symptoms may indicate ongoing infection requiring additional intervention

4. Overlooking rare complications: In rare cases, prolonged doxycycline use has been associated with autoimmune phenomena 4, though this is unlikely in your case given the relatively short duration of therapy

Remember to maintain good hydration, take doxycycline with food to minimize GI side effects, and seek prompt medical attention if your symptoms worsen rather than continue to gradually improve.