From the Guidelines
Doxycycline is effective against a wide range of bacterial infections, including tickborne rickettsial diseases, Lyme disease, and other infections such as respiratory, skin, and urinary tract infections. The most recent and highest quality study, 1, recommends doxycycline as the drug of choice for treatment of all tickborne rickettsial diseases in children and adults. Some of the specific diseases that doxycycline can treat include:
- Tickborne rickettsial diseases, such as Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis 1
- Lyme disease, including early localized and early disseminated disease, as well as late disease manifestations such as arthritis and neurologic disease 1
- Other infections, such as respiratory infections, skin infections, urinary tract infections, and certain sexually transmitted infections like chlamydia 1 It's worth noting that doxycycline can cause photosensitivity, so sun protection is advised during treatment, and it should be avoided in pregnant women and children under 8 years due to potential effects on bone development and tooth discoloration. The typical adult dosage ranges from 100-200 mg daily, usually divided into one or two doses, with treatment duration varying from 7-14 days for most infections. Patients should take doxycycline with plenty of water and remain upright for 30 minutes after taking it to prevent esophageal irritation. In terms of specific treatment recommendations, the study 1 suggests that doxycycline should be initiated promptly in patients with a clinical presentation suggestive of a rickettsial disease, and that treatment should be continued for at least 3 days after fever subsides and until evidence of clinical improvement is noted, with a minimum treatment course of 5-7 days. For Lyme disease, the study 1 recommends doxycycline (100 mg twice per day) for 14 days (range, 10-21 days) for adult patients with early localized or early disseminated disease. Overall, doxycycline is a versatile and effective antibiotic that can be used to treat a wide range of bacterial infections, and its use should be guided by the most recent and highest quality clinical evidence.
From the FDA Drug Label
Doxycycline is indicated for the treatment of the following infections: Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae. Respiratory tract infections caused by Mycoplasma pneumoniae. Lymphogranuloma venereum caused by Chlamydia trachomatis. Psittacosis (ornithosis) caused by Chlamydia psittaci. Trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated, as judged by immunofluorescence. Inclusion conjunctivitis caused by Chlamydia trachomatis. Uncomplicated urethral, endocervical, or rectal infections in adults caused by Chlamydia trachomatis. Nongonococcal urethritis caused by Ureaplasma urealyticum. Relapsing fever due to Borrelia recurrentis. Doxycycline is also indicated for the treatment of infections caused by the following gram-negative microorganisms: Chancroid caused by Haemophilus ducreyi. Plague due to Yersinia pestis (formerly Pasteurella pestis). Tularemia due to Francisella tularensis (formerly Pasteurella tularensis). Cholera caused by Vibrio cholerae (formerly Vibrio comma). Campylobacter fetus infections caused by Campylobacter fetus (formerly Vibrio fetus). Brucellosis due to Brucella species (in conjunction with streptomycin). Bartonellosis due to Bartonella bacilliformis. Granuloma inguinale caused by Calymmatobacterium granulomatis. Doxycycline is indicated for treatment of infections caused by the following gram- negative microorganisms, when bacteriologic testing indicates appropriate susceptibility to the drug: Escherichia coli. Enterobacter aerogenes (formerly Aerobacter aerogenes). Shigella species. Acinetobacter species (formerly Mima species and Herellea species). Respiratory tract infections caused by Haemophilus influenzae. Respiratory tract and urinary tract infections caused by Klebsiella species. Doxycycline is indicated for treatment of infections caused by the following gram-positive microorganisms when bacteriologic testing indicates appropriate susceptibility to the drug: Upper respiratory infections caused by Streptococcus pneumoniae (formerly Diplococcus pneumoniae) Anthrax due to Bacillus anthracis, including inhalational anthrax (post-exposure): to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis. When penicillin is contraindicated, doxycycline is an alternative drug in the treatment of the following infections: Uncomplicated gonorrhea caused by Neisseria gonorrhoeae. Syphilis caused by Treponema pallidum. Yaws caused by Treponema pertenue. Listeriosis due to Listeria monocytogenes. Vincent’s infection caused by Fusobacterium fusiforme. Actinomycosis caused by Actinomyces israelii. Infections caused by Clostridium species. In acute intestinal amebiasis, doxycycline may be a useful adjunct to amebicides. In severe acne, doxycycline may be useful adjunctive therapy.
Doxycycline treats the following diseases:
- Bacterial infections:
- Rocky Mountain spotted fever
- Typhus fever
- Q fever
- Rickettsialpox
- Tick fevers
- Respiratory tract infections caused by Mycoplasma pneumoniae
- Lymphogranuloma venereum
- Psittacosis
- Trachoma
- Inclusion conjunctivitis
- Uncomplicated urethral, endocervical, or rectal infections
- Nongonococcal urethritis
- Relapsing fever
- Chancroid
- Plague
- Tularemia
- Cholera
- Campylobacter fetus infections
- Brucellosis
- Bartonellosis
- Granuloma inguinale
- Gram-negative bacterial infections:
- Escherichia coli
- Enterobacter aerogenes
- Shigella species
- Acinetobacter species
- Haemophilus influenzae
- Klebsiella species
- Gram-positive bacterial infections:
- Upper respiratory infections caused by Streptococcus pneumoniae
- Anthrax
- Other infections:
- Uncomplicated gonorrhea
- Syphilis
- Yaws
- Listeriosis
- Vincent’s infection
- Actinomycosis
- Infections caused by Clostridium species
- Acute intestinal amebiasis (as an adjunct to amebicides)
- Severe acne (as an adjunctive therapy) 2
From the Research
Diseases Treated by Doxycycline
Doxycycline is used to treat various diseases, including:
- Rocky Mountain spotted fever 3, 4
- Lyme disease 3, 4, 5, 6, 7
- Ehrlichiosis 3, 4
- Relapsing fever 3, 4
- Babesiosis, although doxycycline is not explicitly mentioned as a treatment in the provided studies, it is mentioned as a tick-borne disease 3
- Tularemia, although doxycycline is not explicitly mentioned as a treatment in the provided studies, it is mentioned as a tick-borne disease 3
- Borrelia culture-positive erythema migrans 5
Treatment Considerations
When considering treatment with doxycycline, the following should be taken into account:
- Doxycycline is active against the causative organisms of tick-borne diseases, simplifying empiric treatment 4
- The drug of choice for patients from endemic areas where exposure to multiple pathogens may have occurred is doxycycline due to its decreased frequency of administration and adverse effects 4
- Doxycycline is preferred over other antibiotics for the treatment of certain diseases due to its efficacy and safety profile 4, 5