Intravenous Minocycline Dosing Protocol for Severe Infections
For severe infections requiring intravenous minocycline, the recommended adult dosage is a 200 mg loading dose followed by 100 mg every 12 hours. 1
Adult Dosing
- The standard adult dosing protocol consists of 200 mg IV initially as a loading dose, followed by 100 mg every 12 hours 1, 2
- The loading dose should be infused over 60 minutes to minimize adverse effects 1
- For methicillin-resistant Staphylococcus aureus (MRSA) infections, this same dosing regimen is recommended by the Infectious Diseases Society of America 1
- For multidrug-resistant organisms (MDROs), including Acinetobacter baumannii, this dosing regimen has shown efficacy in clinical experience 3
Pediatric Dosing
- For children aged ≥1 month to ≤17 years, the recommended dosing is 4 mg/kg loading dose (maximum 200 mg), followed by 2 mg/kg every 12 hours (maximum 100 mg/dose) 1, 2
- Minocycline should not be used in children under 8 years of age due to the risk of dental staining, unless alternative therapies are ineffective or contraindicated 1
Duration of Therapy
- For plague infections, the recommended treatment duration is 10-14 days 1
- For MRSA skin and soft tissue infections, treatment should continue for 7-14 days 1
- For bacteremia, the recommended duration is 7-14 days 1
- For Mycobacterium marinum infections, a longer course of 6-8 weeks is typically required 2
Special Considerations
- The total daily dosage should not exceed 200 mg in 24 hours 2
- In patients with renal impairment (CrCl <80 mL/min), pharmacokinetic data are insufficient to determine if dosage adjustment is warranted 2
- BUN and creatinine should be monitored in patients with renal impairment due to the antianabolic effect of tetracyclines 2
- Tetracyclines, including minocycline, should be used with caution in patients with chronic kidney disease due to potential nephrotoxicity 4
- Adequate fluid intake is recommended during therapy to reduce the risk of esophageal irritation 2
Transition to Oral Therapy
- Consider transition to oral therapy when clinically appropriate 1
- Minocycline has excellent oral bioavailability, making it suitable for IV to oral switch therapy 3, 5
- For uncomplicated venous access device-related bloodstream infections with coagulase-negative staphylococci, oral minocycline (200 mg loading dose followed by 100 mg twice daily) has been used successfully after initial IV therapy 6
Common Side Effects and Monitoring
- Monitor for vestibular disturbances (vertigo), which can occur with minocycline therapy 7
- Watch for potential photosensitivity reactions, although minocycline has less photosensitizing potential than other tetracyclines 7, 8
- Skin pigmentation may occur with higher cumulative doses (>70g) and longer treatment durations 8
Cautions
- Minocycline is not typically recommended as first-line therapy for complicated bacteremia 9
- For serious bloodstream infections, guidelines emphasize caution when transitioning from parenteral to oral agents, particularly in complicated cases 9
- Long-term high-dose therapy (up to 200 mg/day) has been shown to be safe in acne treatment, but monitoring for side effects is still recommended 8