Doxycycline Dosing for PEG Tube Site Infection
For treating an infection at a percutaneous endoscopic gastrostomy (PEG) tube site, doxycycline should be administered at 100 mg orally twice daily for 7 days. 1
Treatment Algorithm for PEG Tube Site Infections
First-Line Treatment
- Doxycycline 100 mg orally twice daily for 7 days
- Take with a full glass of water
- Remain upright for at least 30 minutes after taking
- Avoid taking within 2 hours of antacids, dairy products, or supplements
Alternative Options (if doxycycline is contraindicated)
- Azithromycin 1 g orally in a single dose 1
- Erythromycin base 500 mg orally four times daily for 7 days 1
- Erythromycin ethylsuccinate 800 mg orally four times daily for 7 days 1
- Ofloxacin 300 mg orally twice daily for 7 days 1
- Levofloxacin 500 mg orally once daily for 7 days 1
Management of PEG Site Infections
Diagnosis
- Inspect for signs of infection:
- Erythema extending >5 mm from stoma site
- Purulent discharge
- Pain/tenderness
- Induration
- Fever or leukocytosis 2
Initial Approach
- Obtain swab for microbiological examination before starting antibiotics 2
- Begin topical antimicrobial treatment to the entry site 2
- Initiate systemic antibiotics (doxycycline as recommended above)
- Ensure proper wound care:
- Clean site daily with soap and water
- Apply antiseptic solution
- Apply sterile dressing 2
Monitoring and Follow-up
- Assess response within 48-72 hours
- If no improvement or worsening infection despite antibiotics, consider:
- Changing antibiotics based on culture results
- Removing and replacing the PEG tube 2
Special Considerations
Contraindications to Doxycycline
- Pregnancy (use azithromycin instead)
- Children under 8 years (risk of dental staining)
- Known hypersensitivity to tetracyclines 1
Common Side Effects of Doxycycline
- Gastrointestinal: nausea, vomiting, diarrhea, esophageal irritation
- Dermatological: photosensitivity
- Genitourinary: vaginal yeast infections 1
Prevention of PEG Site Infections
- Antibiotic prophylaxis at time of PEG placement significantly reduces infection risk 3, 4
- Proper daily wound care with antiseptic measures 2
- Regular inspection of the PEG site during dressing changes 2
PEG tube site infections are common complications, occurring in approximately 15% of cases 2. Most can be effectively managed with proper wound care and appropriate antibiotic therapy. The recommended doxycycline regimen has been shown to be effective against common skin and soft tissue pathogens while being cost-effective 5.
If the infection does not respond to initial antibiotic therapy and local wound care within 48-72 hours, or if there are signs of more severe infection (spreading cellulitis, systemic symptoms), reassessment is necessary, and the PEG tube may need to be removed 2.