Minocycline Dosage and Administration for Bacterial Infections
For adult bacterial infections, minocycline should be administered with an initial dose of 200 mg, followed by 100 mg twice daily (every 12 hours). 1
Adult Dosing Regimens
General Bacterial Infections
- Initial dose: 200 mg orally
- Maintenance dose: 100 mg orally every 12 hours 1
- Duration: Continue until clinical improvement allows discontinuation, typically 7-14 days depending on infection type and severity 2
Skin and Soft Tissue Infections (SSTI)
- For methicillin-susceptible Staphylococcus aureus (MSSA): 100 mg orally twice daily 2
- For methicillin-resistant Staphylococcus aureus (MRSA): 100 mg orally twice daily 2
- Not recommended as first-line therapy for staphylococcal infections 3
Acne Vulgaris
- Adjunctive treatment in moderate to severe inflammatory acne: 50-100 mg 1-3 times daily 2
- Not considered first-line antibacterial treatment due to risk of adverse effects compared to other tetracyclines 4
Non-tuberculous Mycobacterial Pulmonary Disease
- 100 mg orally twice daily 2
Pediatric Dosing
- Children ≥8 years of age: 4 mg/kg initially, followed by 2 mg/kg every 12 hours 1
- Should not be used in children under 8 years of age due to risk of permanent teeth discoloration and enamel hypoplasia 2, 1
Administration Guidelines
- Take with adequate amounts of fluid (water) to reduce risk of esophageal irritation 2
- Can be taken with or without food 1
- Take while sitting or standing to prevent esophageal ulceration 2
Contraindications
- Hypersensitivity to minocycline or any tetracycline 2, 1
- Children under 8 years of age 2, 1
- Pregnancy (Category D) 2
- Breastfeeding mothers 2
- Systemic lupus erythematosus (risk of exacerbation) 2
Monitoring Recommendations
- For long-term therapy: Complete blood count weekly for first 2 months, then monthly if stable 2, 1
- Monitor for signs of vestibular disturbances (dizziness, vertigo) 5
- Monitor for hyperpigmentation with long-term use (cumulative doses >70g) 5
- Monitor for signs of lupus-like syndrome or DRESS syndrome 2, 4
- Monitor for visual disturbances (peripheral and optic neuropathy) 1
Adverse Effects
Common Adverse Effects
- Gastrointestinal: nausea, vomiting, diarrhea, epigastric distress 2
- Neurological: dizziness, headache 2
- Dermatological: photosensitivity, rash 2
Serious Adverse Effects
- Hypersensitivity reactions: DRESS syndrome, anaphylaxis 2, 4
- Autoimmune reactions: drug-induced lupus, autoimmune hepatitis 4
- Dermatological: Stevens-Johnson syndrome, toxic epidermal necrolysis 2
- Neurological: benign intracranial hypertension 2
- Hepatotoxicity: hepatitis, liver failure 2
- Pigmentation of skin or other organs with long-term use 5
Drug Interactions
- Antacids containing aluminum, calcium, or magnesium 2
- Oral anticoagulants 2
- Hormonal contraceptives (reduced effectiveness) 2
- Iron-containing preparations 2
Clinical Considerations
- Bacterial resistance to minocycline can develop with prolonged use 4, 6
- Avoid direct exposure to sunlight or UV radiation due to photosensitivity risk 2
- Use with caution in patients with hepatic impairment 2, 1
- Use with caution in patients with renal impairment 1
- Minocycline is not more effective in acne than other tetracyclines but has a higher risk of severe adverse effects 4
By following these dosing guidelines and monitoring recommendations, clinicians can optimize the therapeutic benefits of minocycline while minimizing potential risks to patients.