What is the recommended dosage of intravenous (IV) minocycline?

Intravenous Minocycline Dosage Recommendations

The recommended dosage for intravenous minocycline in adults is a 200 mg loading dose, followed by 100 mg every 12 hours. 1

Adult Dosing

• For treatment of bubonic or pharyngeal plague, the recommended IV minocycline dosage is 200 mg loading dose, then 100 mg every 12 hours 1
• For methicillin-resistant Staphylococcus aureus (MRSA) infections, the dosing remains consistent at 200 mg loading dose, then 100 mg every 12 hours IV 1
• For uncomplicated venous access device-related bloodstream infections, the same dosing regimen is recommended: 200 mg loading dose followed by 100 mg twice daily 2
• In critically ill patients, a regimen of 200 mg IV every 12 hours may be necessary to achieve adequate pharmacodynamic targets, especially for infections with MIC values >1 mg/liter 3

Pediatric Dosing

• For children ≥1 month to ≤17 years, the recommended IV minocycline dosage is 4 mg/kg loading dose (maximum 200 mg), then 2 mg/kg every 12 hours (maximum 100 mg/dose) 1
• Minocycline should not be used in children under 8 years of age due to the risk of dental staining, unless other appropriate drugs are ineffective or contraindicated 1

Special Populations

• For elderly debilitated patients, dosage adjustment based on body weight may be necessary as pharmacokinetic studies show correlation between dose per kg body weight and steady-state concentrations 4
• In patients with renal impairment, no dosage adjustment is typically required as minocycline's half-life is not significantly prolonged in chronic renal failure 5

Duration of Therapy

• Treatment duration depends on the specific indication:
  • For plague: 10-14 days 1
  • For MRSA skin and soft tissue infections: 7-14 days 1
  • For bacteremia: 7-14 days 1

Administration Considerations

• Intravenous minocycline should be infused over 60 minutes 5, 3
• IV administration is primarily indicated for unconscious or vomiting patients, or those unable to take oral medication 5

Monitoring and Safety Considerations

• Monitor for adverse effects including:
  • Vestibular disturbances 6
  • Gastrointestinal disturbances 6
  • Cutaneous reactions including pigmentation (especially with cumulative doses >70g) 6
  • Photosensitivity reactions 7
• Long-term high-dose therapy (up to 200 mg/day) has been shown to be safe when clinically necessary, though pigmentation risk increases with higher doses 6

Practical Application

1. Start with loading dose of 200 mg IV infused over 60 minutes
2. Continue with maintenance dose of 100 mg IV every 12 hours
3. Adjust dosage for pediatric patients based on weight (4 mg/kg loading, then 2 mg/kg every 12 hours)
4. Consider transition to oral therapy when clinically appropriate
5. Complete full course of therapy based on indication (typically 7-14 days)