From the Guidelines
Doxycycline is generally associated with a lower incidence of diarrhea compared to other broad-spectrum antibiotics.
Key Points
- In a typical dosage of 100mg twice daily for 7-14 days, doxycycline tends to cause less gastrointestinal disturbance, including diarrhea, than antibiotics such as amoxicillin-clavulanate or ciprofloxacin 1.
- The incidence of diarrhea with doxycycline is estimated to be around 5-10%, which is significantly lower than the 20-30% incidence observed with other antibiotics like cefaclor or azithromycin 1.
- Taking doxycycline with food and adequate fluids in the upright position may reduce gastrointestinal side effects, including diarrhea 1.
- Doxycycline has been shown to be highly effective in the treatment of erythema migrans and associated symptoms in prospective studies, with a low frequency of serious adverse effects 1.
- It is recommended to take doxycycline with 8 ounces of fluid to reduce the risk of esophageal irritation and with food to reduce gastrointestinal intolerance 1.
From the FDA Drug Label
Adverse Reactions Due to oral doxycycline’s virtually complete absorption, side effects of the lower bowel, particularly diarrhea, have been infrequent The following adverse reactions have been observed in patients receiving tetracyclines: Gastrointestinal: anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, and inflammatory lesions (with monilial overgrowth) in the anogenital region.
The antibiotic doxycycline causes less diarrhea compared to other antibiotics in its class, as it is virtually completely absorbed and therefore has infrequent side effects on the lower bowel 2.
- Diarrhea is listed as a possible adverse reaction, but it is noted to be infrequent.
- The low incidence of diarrhea can be attributed to the drug's high absorption rate.
From the Research
Antibiotic-Associated Diarrhea
- The incidence of antibiotic-associated diarrhea (AAD) can be triggered by any antibiotic 3
- Almost all antibiotics, except tobramycin and minocycline, showed a significant correlation with AAD 4
- Lincomycins, third-generation cephalosporins, and first/second generation cephalosporins ranked the top three in terms of correlation with AAD 4
Doxycycline and Diarrhea
- Doxycycline is a broad-spectrum antimicrobial agent with a low incidence of bacterial resistance 5
- Doxycycline has been shown to be effective in the prevention of traveler's diarrhea 6
- However, gastrointestinal side effects, including diarrhea, are possible with doxycycline use 5
Comparison with Other Antibiotics
- The risk of AAD varies among different classes of antibiotics, with lincomycins and β-lactam antibiotics showing a higher correlation with AAD 4
- Doxycycline, a tetracycline antibiotic, is not specifically mentioned as having a high or low correlation with AAD in the studies provided 5, 6, 4
- The use of amoxicillin-clavulanic acid, a β-lactam antibiotic, was increased in a study that restricted the use of broad-spectrum antibiotics, with no significant difference in the rate of C. difficile infections observed 7