Minocycline Dosage for Bacterial Infections
For adult bacterial infections, minocycline should be dosed at 200 mg initially, followed by 100 mg twice daily (every 12 hours). 1
Adult Dosing Guidelines
Standard Dosing
- Initial dose: 200 mg orally
- Maintenance dose: 100 mg orally every 12 hours 1
- Duration: 5-10 days for skin and soft tissue infections 1
Specific Indications
- Outpatient skin and soft tissue infections (SSTI): 200 mg initially, then 100 mg PO every 12 hours 1
- Chronic suppression for prosthetic joint infections: 100 mg PO twice daily 1
- Non-tuberculous mycobacterial pulmonary disease: 100 mg twice daily 1
Pediatric Dosing
- Children ≥8 years: 4 mg/kg initially, followed by 2 mg/kg every 12 hours 1
- Not recommended for children under 8 years of age due to risk of permanent teeth discoloration and enamel hypoplasia 1
Important Considerations
Contraindications
- Hypersensitivity to minocycline or other tetracyclines 1
- Children under 8 years of age 1
- Pregnancy and breastfeeding 1
- Systemic lupus erythematosus (risk of exacerbation) 1
Common Adverse Effects
- Vestibular disturbances (dizziness, vertigo) 1, 2
- Gastrointestinal effects (nausea, vomiting, diarrhea) 1
- Photosensitivity (though less than other tetracyclines) 2, 3
- Skin hyperpigmentation (with cumulative doses >70g) 3
Monitoring Requirements
- For long-term therapy: Complete blood count weekly for first 2 months, then monthly if stable 1
- Monitor for signs of lupus-like syndrome 1
- Monitor for visual disturbances (peripheral and optic neuropathy) 1
Clinical Pearls
- Take with plenty of water during meals while sitting or standing to prevent esophageal irritation 1
- Avoid direct sunlight exposure to minimize photosensitivity risk 1
- Minocycline may be effective against some tetracycline-resistant staphylococci 2
- Higher doses (up to 200 mg daily) may be used for acne treatment with acceptable safety profile 3
- When used for MRSA infections, minocycline should not be used as monotherapy 1
Special Populations
- Renal impairment: No dose adjustment required, but use with caution and monitor for adverse effects 1
- Liver disease: No dose adjustment required, but use with caution due to limited clinical data 1
- Elderly: Standard adult dosing, but monitor more closely for adverse effects
Remember that minocycline has a higher incidence of vestibular side effects compared to other tetracyclines, but has less photosensitizing potential 2. For serious infections, consider combination therapy or alternative agents based on culture and susceptibility results.