What is the dosage of doxycycline (Doxycycline) for the treatment of an abscess?

Doxycycline Dosing for Abscess Treatment

Standard Dosing Regimen

For abscess treatment in adults, doxycycline should be dosed at 100 mg orally or IV every 12 hours, with an initial loading dose of 200 mg on the first day (administered as 100 mg every 12 hours). 1

Critical Limitation: Inadequate Anaerobic Coverage

Doxycycline alone is insufficient for most abscesses because it lacks adequate anaerobic coverage, which is essential for abscess treatment. 2 The American College of Physicians and CDC recommend adding clindamycin when treating abscesses, as treatment failure at 72 hours with doxycycline alone strongly suggests inadequate anaerobic coverage. 2

Recommended Combination Therapy

Outpatient Management

• Clindamycin 450 mg orally four times daily PLUS doxycycline 100 mg orally twice daily 2
• This combination provides the necessary anaerobic coverage that doxycycline alone cannot achieve 2

Severe Infections or Hospitalized Patients

• Clindamycin 900 mg IV every 8 hours PLUS gentamicin (loading dose 2 mg/kg, then 1.5 mg/kg every 8 hours) 2
• Transition to oral doxycycline 100 mg twice daily after clinical improvement, continuing for 14 days total 3

Special Considerations for Tubo-Ovarian Abscess

For tubo-ovarian abscess specifically, the CDC recommends: 4

• Parenteral clindamycin 900 mg IV every 8 hours plus gentamicin (loading dose 2 mg/kg, maintenance 1.5 mg/kg every 8 hours) 4
• Continue parenteral therapy for at least 24 hours after clinical improvement 4
• Transition to oral clindamycin 450 mg four times daily (preferred) OR doxycycline 100 mg twice daily plus metronidazole 500 mg twice daily 4
• Complete 14 days total therapy 4

Alternative parenteral regimen for tubo-ovarian abscess:

• Cefoxitin 2 g IV every 6 hours OR cefotetan 2 g IV every 12 hours PLUS doxycycline 100 mg orally or IV every 12 hours 3

Pediatric Dosing

For children above 8 years of age: 1

• 2 mg/lb body weight divided into two doses on day 1, followed by 1 mg/lb daily (as single dose or divided into two doses) 1
• For severe infections, up to 2 mg/lb may be used 1
• Children over 100 lb should receive adult dosing 1
• Doxycycline is contraindicated in children younger than 8 years 3

Administration Considerations

• Administer with adequate fluid to reduce esophageal irritation risk 1
• If gastric irritation occurs, give with food or milk (absorption not significantly affected) 1
• Oral and IV doxycycline provide similar bioavailability 3
• Oral administration preferred even in hospitalized patients due to pain associated with IV infusion 3

Treatment Failure Protocol

If no clinical improvement occurs within 72 hours of adding clindamycin to doxycycline, hospitalization for parenteral therapy and possible surgical drainage is indicated. 2 Source control through drainage is essential for large abscesses and may be the primary reason for treatment failure rather than antibiotic choice alone. 2