Intravenous Minocycline Dosage for Severe Bacterial Infections
For severe bacterial infections, intravenous minocycline should be administered at an initial loading dose of 200 mg, followed by 100 mg every 12 hours for 7-14 days, depending on clinical response and infection type. 1, 2
Standard Dosing Regimen
Adult Dosing
- Initial dose: 200 mg IV 1, 2
- Maintenance dose: 100 mg IV every 12 hours 1, 2
- Maximum daily dose: 400 mg (200 mg every 12 hours) 1
Pediatric Dosing (children ≥8 years)
- Initial dose: 4 mg/kg IV 1, 2
- Maintenance dose: 2 mg/kg IV every 12 hours 1, 2
- Maximum dose: Not to exceed usual adult dose 1
Treatment Duration by Infection Type
- Skin and soft tissue infections (SSTI): 7-14 days 3
- Complicated bacteremia: 4-6 weeks 3
- Uncomplicated gonococcal infections: Minimum 4 days 1
- Syphilis: 10-15 days 1
- Meningococcal carrier state: 5 days 1
- Mycobacterium marinum infections: 6-8 weeks 1
- Chlamydia trachomatis/Ureaplasma urealyticum infections: At least 7 days 1
Special Considerations
Renal Impairment
- No specific dosage adjustment is recommended for renal impairment 1, 2
- However, monitor BUN and creatinine due to the antianabolic effect of tetracyclines 1
- Use with caution in patients with renal dysfunction 2
Administration Guidelines
- May be administered with or without food 1
- Ensure adequate fluid intake to reduce risk of esophageal irritation 1
- For severe infections, consider initial intravenous therapy with transition to oral therapy when clinically appropriate 3
Monitoring
- For long-term therapy, monitor complete blood count weekly for first 2 months, then monthly if stable 2
- Monitor for signs of lupus-like syndrome 2
- Watch for vestibular disturbances (dizziness, vertigo) which are more common with minocycline than other tetracyclines 2, 4
Clinical Applications
Multidrug-Resistant Organisms
- Minocycline retains activity against many multidrug-resistant organisms, including MRSA and Acinetobacter species 5, 6
- For Acinetobacter baumannii infections, minocycline may be used alone or in combination with other agents 5, 6
- Consider combination therapy for severe MDR gram-negative infections 5
Transition from IV to Oral Therapy
- Once clinical improvement is documented, transition to oral minocycline (100 mg every 12 hours) can be considered 3, 5
- The excellent oral bioavailability makes minocycline suitable for IV-to-oral switch therapy 5
Contraindications and Precautions
- Not recommended for children under 8 years due to risk of permanent teeth discoloration 2, 1
- Contraindicated in pregnancy and breastfeeding 2
- Use with caution in patients with systemic lupus erythematosus 2
Adverse Effects to Monitor
- Gastrointestinal effects (nausea, vomiting, diarrhea) 2
- Vestibular disturbances (dizziness, vertigo) 2, 4
- Photosensitivity (though less common with minocycline than other tetracyclines) 4
- Visual disturbances 2
Minocycline IV provides a valuable option for treating severe bacterial infections, particularly those caused by multidrug-resistant organisms, with the advantage of potential transition to oral therapy after clinical improvement.