Doxycycline Dosage

Medically reviewed by Drugs.com. Last updated on Sep 6, 2023.

Usual Adult Dose for Acne

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Actinomycosis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Amebiasis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Chancroid

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Inclusion Conjunctivitis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Mycoplasma Pneumonia

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Pneumonia

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Trachoma

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Upper Respiratory Tract Infection

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Bacterial Infection

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Urinary Tract Infection

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Bronchitis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Psittacosis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Ornithosis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Bartonellosis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections (especially chronic urinary tract infections): 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, infectious agent is not always eliminated (as assessed by immunofluorescence).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of the following infections: Psittacosis (ornithosis) due to Chlamydophila psittaci; chancroid due to Haemophilus ducreyi; relapsing fever due to Borrelia recurrentis; Campylobacter fetus infections; bartonellosis due to Bartonella bacilliformis; trachoma or inclusion conjunctivitis due to Chlamydia trachomatis; respiratory tract infections due to Mycoplasma pneumoniae
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: Escherichia coli; Enterobacter aerogenes; Shigella species; Acinetobacter species; respiratory tract infections due to H influenzae or Klebsiella species; upper respiratory infections due to Streptococcus pneumoniae; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to Treponema pallidum subspecies pertenue; listeriosis due to Listeria monocytogenes; Vincent's infection due to Fusobacterium fusiforme; actinomycosis due to Actinomyces israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

Usual Adult Dose for Acne Rosacea

40 mg orally once a day in the morning

Comments:

• The 40 mg capsule formulation
• This product should be taken on an empty stomach, preferably at least 1 hour prior to or 2 hours after meals.
• No meaningful effect shown for generalized erythema of rosacea.
• Safety and efficacy have not been established beyond 9 months and 16 weeks, respectively.
• This product has not been evaluated for treatment of erythematous, telangiectatic, or ocular components of rosacea.

Use: For the treatment of only inflammatory lesions (papules and pustules) of rosacea

Usual Adult Dose for Inhalation Bacillus anthracis

Most products: 100 mg orally or IV twice a day

• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 60 days

Comments:

• Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
• Oral therapy should be started as soon as possible.
• Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to Bacillus anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

US CDC Recommendations:

• IV: 200 mg IV initially then 100 mg IV every 12 hours
• Oral: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:

• When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
• Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:

• Bioterrorism-related cases: 60 days
• Naturally-acquired cases: 7 to 10 days

Comments:

• Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
• Recommended as an alternative IV protein synthesis inhibitor for systemic anthrax when meningitis has been excluded
• Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
• Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Cutaneous Bacillus anthracis

Most products: 100 mg orally or IV twice a day

• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 60 days

Comments:

• Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
• Oral therapy should be started as soon as possible.
• Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to Bacillus anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

US CDC Recommendations:

• IV: 200 mg IV initially then 100 mg IV every 12 hours
• Oral: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:

• When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
• Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:

• Bioterrorism-related cases: 60 days
• Naturally-acquired cases: 7 to 10 days

Comments:

• Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
• Recommended as an alternative IV protein synthesis inhibitor for systemic anthrax when meningitis has been excluded
• Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
• Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Anthrax Prophylaxis

Most products: 100 mg orally or IV twice a day

• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 60 days

Comments:

• Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
• Oral therapy should be started as soon as possible.
• Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to Bacillus anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

US CDC Recommendations:

• IV: 200 mg IV initially then 100 mg IV every 12 hours
• Oral: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days

Systemic anthrax:

• When meningitis has been excluded: At least 2 weeks or until patient is clinically stable (whichever is longer)
• Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial regimen of 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:

• Bioterrorism-related cases: 60 days
• Naturally-acquired cases: 7 to 10 days

Comments:

• Recommended as a preferred oral drug for postexposure prophylaxis and for the treatment of cutaneous anthrax without systemic involvement
• Recommended as an alternative IV protein synthesis inhibitor for systemic anthrax when meningitis has been excluded
• Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
• Systemic anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Brucellosis

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• Coadministration with streptomycin is recommended.
• According to some experts, this drug should be used with rifampin for at least 6 to 8 weeks; current guidelines should be consulted for additional information.

Use: For the treatment of brucellosis due to Brucella species

Usual Adult Dose for Cholera

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of cholera due to Vibrio cholerae

Infectious Diseases Society of America (IDSA) and Pan American Health Organization (PAHO) Recommendations: 300 mg orally once

Comments:

• Recommended for the treatment of infectious diarrhea due to V cholerae O1 or O139
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Chlamydia Infection

Uncomplicated urethral, endocervical, or rectal infection:

• Most products: 100 mg orally twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Alternative regimen for uncomplicated urethral or endocervical infection:

• Delayed-release tablets: 200 mg orally once a day

Duration of therapy: 7 days

Comments:

• These regimens (100 mg orally twice a day and 200 mg orally once a day) have been recommended by the US CDC for the treatment of chlamydial infections; current guidelines should be consulted for additional information.
• The patient's sexual partner(s) should also be evaluated/treated.

Uses: For the treatment of uncomplicated urethral, endocervical, or rectal infections due to C trachomatis

Usual Adult Dose for Epididymitis - Sexually Transmitted

Most products: 100 mg orally twice a day

• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: At least 10 days

Use: For the treatment of acute epididymo-orchitis due to C trachomatis or Neisseria gonorrhoeae

US CDC Recommendations: 100 mg orally twice a day for 10 days

Comments:

• With ceftriaxone, the recommended regimen for acute epididymitis most likely due to sexually transmitted chlamydia and gonorrhea
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Gonococcal Infection - Uncomplicated

Most products: 100 mg orally twice a day

• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 7 days

Alternate single visit dose:

• Most products: 300 mg orally initially followed in 1 hour by a second 300 mg dose
• Alternatively, Doryx(R) MPC: 360 mg orally initially followed in 1 hour by a second 360 mg dose

Comments:

• Not recommended for anorectal infections in men.

Use: For the treatment of uncomplicated gonorrhea due to N gonorrhoeae

US CDC Recommendations: 100 mg orally twice a day for 7 days

Comments:

• With ceftriaxone (or cefixime), recommended for uncomplicated infections of the cervix, urethra, or rectum as an alternative second antimicrobial in patients with azithromycin allergy
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Granuloma Inguinale

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of granuloma inguinale due to Klebsiella granulomatis

US CDC Recommendations: 100 mg orally twice a day
Duration of therapy: At least 3 weeks and until all lesions have completely healed

Comments:

• Recommended as an alternative regimen
• Another antibiotic (e.g., an aminoglycoside such as gentamicin) may be added if no improvement is observed after several days.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lymphogranuloma Venereum

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of lymphogranuloma venereum due to C trachomatis

US CDC Recommendations: 100 mg orally twice a day for 21 days

Comments:

• Recommended as the preferred regimen
• Patients should be clinically monitored until signs/symptoms have resolved.
• Prolonged therapy may be needed for HIV-infected patients; delay in symptom resolution may occur.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Nongonococcal Urethritis

Most products: 100 mg orally twice a day

• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 7 days

Comments:

• According to the US CDC, this (100 mg orally twice a day) is a recommended regimen for chlamydial urethritis; current guidelines should be consulted for additional information.
• The patient's sexual partner(s) should also be evaluated/treated.

Use: For the treatment of nongonococcal urethritis due to C trachomatis or Ureaplasma urealyticum

Usual Adult Dose for Malaria Prophylaxis

Most products: 100 mg orally once a day

• Alternatively, Doryx(R) MPC: 120 mg orally once a day

Comments:

• Prophylaxis should start 1 to 2 days before travel to endemic area; should continue daily while in malarious areas and for 4 weeks after leaving such areas
• Prophylaxis with this drug should not exceed 4 months.

Use: For prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

US CDC Recommendations: 100 mg orally once a day

Comments:

• Recommended for prophylaxis in all areas
• Not recommended for use during pregnancy.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Malaria

US CDC Recommendations:

• Uncomplicated malaria: 100 mg orally twice a day for 7 days
• Severe malaria: 100 mg orally or IV twice a day for 7 days

Comments:

• With quinine, recommended for uncomplicated malaria due to chloroquine-resistant P falciparum
• With quinine and primaquine, recommended for uncomplicated malaria due to chloroquine-resistant P vivax
• With quinine, recommended for severe malaria
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Periodontitis

20 mg orally twice a day for up to 9 months

Comments:

• The 20 mg capsule or tablet formulation
• This product should be taken at least 1 hour prior to or 2 hours after meals.
• Safety and efficacy have not been established beyond 12 months and 9 months, respectively.

Use: As an adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in patients with periodontitis

Usual Adult Dose for Plague

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of plague due to Yersinia pestis

US CDC Recommendations: 100 mg orally or IV twice a day or 200 mg orally or IV once a day
Duration of therapy: 10 to 14 days (or until 2 days after fever subsides)

Comments:

• In general, recommended as an alternative regimen for the treatment of plague
• IV therapy should be started as soon as plague suspected; may switch to oral therapy once patient improves
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Plague Prophylaxis

US CDC Recommendations: 100 mg orally twice a day for 7 days

Comments:

• Recommended as a preferred agent for postexposure prophylaxis in patients with known exposure to plague (e.g., close contact with pneumonic plague patient, direct contact with infected body fluids/tissues)
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Rickettsial Infection

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Uses: For the treatment of rickettsial infections including Rocky Mountain spotted fever (RMSF), typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species

US CDC Recommendations: 100 mg orally or IV twice a day

Duration of Therapy:

• RMSF, ehrlichiosis: At least 3 days after fever subsides and until evidence of clinical improvement
• Anaplasmosis: 10 days

Comments:

• Recommended as drug of choice for all tickborne rickettsial diseases
• Tickborne rickettsial diseases include RMSF due to Rickettsia rickettsii, other spotted fever group rickettsioses due to R parkeri and Rickettsia species 364D, Ehrlichia chaffeensis ehrlichiosis (i.e., human monocytic ehrlichiosis), other ehrlichioses due to E ewingii and E muris-like agent, and anaplasmosis due to Anaplasma phagocytophilum (i.e., human granulocytic anaplasmosis).
• The usual minimum duration of therapy for RMSF and ehrlichiosis is 5 to 7 days (total); severe/complicated disease may require longer therapy.
• According to some experts, typical duration of therapy for ehrlichiosis is 7 to 14 days.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Q Fever

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Uses: For the treatment of rickettsial infections including Rocky Mountain spotted fever (RMSF), typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species

US CDC Recommendations: 100 mg orally or IV twice a day

Duration of Therapy:

• RMSF, ehrlichiosis: At least 3 days after fever subsides and until evidence of clinical improvement
• Anaplasmosis: 10 days

Comments:

• Recommended as drug of choice for all tickborne rickettsial diseases
• Tickborne rickettsial diseases include RMSF due to Rickettsia rickettsii, other spotted fever group rickettsioses due to R parkeri and Rickettsia species 364D, Ehrlichia chaffeensis ehrlichiosis (i.e., human monocytic ehrlichiosis), other ehrlichioses due to E ewingii and E muris-like agent, and anaplasmosis due to Anaplasma phagocytophilum (i.e., human granulocytic anaplasmosis).
• The usual minimum duration of therapy for RMSF and ehrlichiosis is 5 to 7 days (total); severe/complicated disease may require longer therapy.
• According to some experts, typical duration of therapy for ehrlichiosis is 7 to 14 days.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Skin or Soft Tissue Infection

Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
Maintenance dose: 100 to 200 mg/day IV

Comments:

• Not the drug of choice for any type of staphylococcal infection
• The maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.

Use: For the treatment of skin and soft tissue infections due to Staphylococcus aureus when bacteriological testing shows suitable susceptibility to this drug

IDSA Recommendations: 100 mg orally or IV every 12 hours

Comments:

• Recommended as oral therapy for skin and soft tissue infections due to methicillin-susceptible and methicillin-resistant S aureus, bacillary angiomatosis, bubonic plague, tularemia, and infections after human bites
• Recommended as oral therapy for purulent cellulitis (cellulitis associated with purulent drainage/exudate without a drainable abscess) due to methicillin-resistant S aureus
• With other agents, recommended as a part of an IV regimen for necrotizing infections of the skin, fascia, and muscle due to Aeromonas hydrophila or V vulnificus
• Recommended oral or IV therapy for infections after animal bites
• Recommended duration of therapy for bacillary angiomatosis is 2 weeks to 2 months
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Syphilis - Early

Early:

• Most products: 100 mg orally twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 2 weeks

More than 1-year duration:

• Most products: 100 mg orally twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 4 weeks

For the treatment of primary or secondary syphilis, some manufacturers recommend: 300 mg/day orally (in divided doses) or IV for at least 10 days

Comments:

• Penicillin is the drug of choice.
• The patient's sexual partner(s) should also be evaluated/treated.

Use: When penicillin is contraindicated, as alternative therapy for syphilis due to T pallidum

US CDC Recommendations:

• Primary or secondary syphilis: 100 mg orally twice a day for 14 days
• Latent syphilis: 100 mg orally twice a day for 28 days

Comments:

• Recommended for nonpregnant penicillin-allergic patients
• Penicillin-allergic pregnant patients or penicillin-allergic patients whose compliance cannot be ensured should be desensitized and treated with benzathine penicillin.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Syphilis - Latent

Early:

• Most products: 100 mg orally twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 2 weeks

More than 1-year duration:

• Most products: 100 mg orally twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 4 weeks

For the treatment of primary or secondary syphilis, some manufacturers recommend: 300 mg/day orally (in divided doses) or IV for at least 10 days

Comments:

• Penicillin is the drug of choice.
• The patient's sexual partner(s) should also be evaluated/treated.

Use: When penicillin is contraindicated, as alternative therapy for syphilis due to T pallidum

US CDC Recommendations:

• Primary or secondary syphilis: 100 mg orally twice a day for 14 days
• Latent syphilis: 100 mg orally twice a day for 28 days

Comments:

• Recommended for nonpregnant penicillin-allergic patients
• Penicillin-allergic pregnant patients or penicillin-allergic patients whose compliance cannot be ensured should be desensitized and treated with benzathine penicillin.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Tularemia

IV:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• If using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of tularemia due to Francisella tularensis

Working Group on Civilian Biodefense Recommendations: 100 mg orally or IV twice a day

Duration of Therapy:

• Postexposure prophylaxis: 14 days
• Treatment in a contained casualty setting: At least 14 days
• Treatment in a mass casualty setting: 14 to 21 days

Comments:

• Recommended as an alternative IV regimen for the treatment of tularemia in a contained casualty setting and for postexposure prophylaxis
• Recommended as a preferred oral regimen for the treatment of tularemia in a mass casualty setting and for postexposure prophylaxis
• If parenteral therapy is used initially, may switch to oral therapy when clinically indicated
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Cervicitis

US CDC Recommendations: 100 mg orally twice a day for 7 days

Comments:

• Recommended regimen for presumptive therapy
• Concomitant treatment for gonococcal infection should be considered if patient is at risk for or lives in a community with a high incidence of gonorrhea.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Joint Infection

IDSA Recommendations: 100 mg orally twice a day

Comments:

• Recommended for chronic oral antimicrobial suppression for prosthetic joint infection; as a preferred regimen against oxacillin-resistant staphylococci and as an alternative regimen against Propionibacterium species

Usual Adult Dose for Lyme Disease - Arthritis

IDSA Recommendations: 100 mg orally twice a day

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease - Carditis

IDSA Recommendations: 100 mg orally twice a day

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease - Erythema Chronicum Migrans

IDSA Recommendations: 100 mg orally twice a day

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease

IDSA Recommendations: 100 mg orally twice a day

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Lyme Disease - Neurologic

IDSA Recommendations: 100 to 200 mg orally twice a day
Duration of therapy: 14 days (range: 10 to 28 days)

Comments:

• Recommended as the preferred regimen for the treatment of nervous system Lyme disease (including the following syndromes: meningitis, any neurologic syndrome with CSF pleocytosis, peripheral nerve [radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF])
• Recommended in early Lyme disease for patients intolerant of beta-lactam antibiotics with acute neurologic disease manifested by meningitis or radiculopathy
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Melioidosis

US CDC Recommendations: 100 mg orally every 12 hours
Duration of therapy: 3 to 6 months

Comments:

• This oral regimen may be started after 10 to 14 days of IV therapy.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Pelvic Inflammatory Disease

US CDC Recommendations: 100 mg orally or IV every 12 hours
Duration of therapy: 14 days

Comments:

• With other agents, recommended as part of a parenteral regimen or as part of an IM/oral regimen; also recommended as part of an alternative parenteral regimen
• This drug may be switched from IV to oral administration 24 to 48 hours after clinical improvement to complete 14 days of therapy.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Sinusitis

IDSA Recommendations: 100 mg orally twice a day or 200 mg orally once a day

Comments:

• Recommended as a second-line regimen for acute bacterial rhinosinusitis, as initial empirical therapy or for patients with beta-lactam allergy
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Proctitis

US CDC Recommendations: 100 mg orally twice a day for 7 days

Comments:

• With ceftriaxone, the recommended regimen for sexually-acquired acute proctitis
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Wound Infection

US CDC Recommendations: 100 mg orally or IV twice a day for 7 to 14 days

Comments:

• In combination with a third-generation cephalosporin (e.g., ceftazidime), recommended for the treatment of V vulnificus wound infections
• Current guidelines should be consulted for additional information.

Usual Adult Dose for Pleural Effusion

Some Experts Recommend:

• Sclerosing agent: Mix 500 mg of the powder for injection and 10 mL of lidocaine 1% in 50 mL of normal saline and inject into pleural space.

Comments:

• Clinical trials have reported use of doses ranging from 250 mg to 1 g.

Usual Pediatric Dose for Acne

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Actinomycosis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Amebiasis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Brucellosis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Chancroid

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Inclusion Conjunctivitis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Trachoma

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bacterial Infection

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Urinary Tract Infection

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Psittacosis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Ornithosis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bartonellosis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• With trachoma, the infectious agent is not always eliminated (as assessed by immunofluorescence).
• Coadministration with streptomycin recommended for brucellosis.

Uses:

• For the treatment of the following infection: Psittacosis (ornithosis) due to C psittaci; chancroid due to H ducreyi; relapsing fever due to B recurrentis; C fetus infections; brucellosis due to Brucella species; bartonellosis due to B bacilliformis; trachoma or inclusion conjunctivitis due to C trachomatis
• For the treatment of infections due to the following bacteria when bacteriological testing shows suitable susceptibility to this drug: E coli; E aerogenes; Shigella species; Acinetobacter species; urinary tract infections due to Klebsiella species
• When penicillin is contraindicated, as an alternative agent for the treatment of the following infections: Yaws due to T pallidum subspecies pertenue; listeriosis due to L monocytogenes; Vincent's infection due to F fusiforme; actinomycosis due to A israelii; infections due to Clostridium species
• As adjunctive therapy for: Acute intestinal amebiasis; severe acne

American Academy of Pediatrics (AAP) Recommendations:
1 month or older:

• Mild to moderate infections: 2 to 4 mg/kg/day orally or IV in 1 to 2 divided doses
• Severe infections: 2 mg/kg orally or IV every 12 hours

Maximum dose: 200 mg/day

Comments:

• Risk of dental staining in children younger than 8 years is unlikely at the dose and duration recommended to treat serious infections.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Inhalation Bacillus anthracis

Less than 45 kg:

• Most products: 2.2 mg/kg orally or IV twice a day
• Alternatively, Doryx(R) MPC: 2.6 mg/kg orally twice a day

At least 45 kg:

• Most products: 100 mg orally or IV twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 60 days

Comments:

• Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
• Oral therapy should be started as soon as possible.
• Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

AAP Recommendations:
Term neonate (younger than 1 month): 4.4 mg/kg orally or IV initially then 2.2 mg/kg orally or IV every 12 hours

Children 1 month or older:
IV:

• Less than 45 kg: 4.4 mg/kg IV initially then 2.2 mg/kg IV every 12 hours
• At least 45 kg: 200 mg IV initially then 100 mg IV every 12 hours

ORAL:

• Less than 45 kg: 2.2 mg/kg orally every 12 hours
• At least 45 kg: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days after exposure

Systemic/severe anthrax when meningitis has been excluded:

• Term neonate (younger than 1 month): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
• Children 1 month or older: At least 14 days or until patient is clinically stable (whichever is longer)
• Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:

• Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
• Naturally-acquired cases: 7 to 10 days

Follow-up for severe anthrax:

• Term neonate (younger than 1 month): To complete a regimen of at least 10 to 14 days
• Children 1 month or older: To complete a regimen of at least 14 days
• Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:

• Recommended for postexposure prophylaxis as a preferred oral drug in children 1 month or older and as an alternative oral drug for term neonates (younger than 1 month)
• Recommended as an alternative oral drug for the treatment of cutaneous anthrax without systemic involvement
• Recommended as an alternative protein synthesis inhibitor for the IV treatment of systemic/severe anthrax when meningitis has been excluded and for oral follow-up for severe anthrax
• Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
• Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Cutaneous Bacillus anthracis

Less than 45 kg:

• Most products: 2.2 mg/kg orally or IV twice a day
• Alternatively, Doryx(R) MPC: 2.6 mg/kg orally twice a day

At least 45 kg:

• Most products: 100 mg orally or IV twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 60 days

Comments:

• Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
• Oral therapy should be started as soon as possible.
• Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

AAP Recommendations:
Term neonate (younger than 1 month): 4.4 mg/kg orally or IV initially then 2.2 mg/kg orally or IV every 12 hours

Children 1 month or older:
IV:

• Less than 45 kg: 4.4 mg/kg IV initially then 2.2 mg/kg IV every 12 hours
• At least 45 kg: 200 mg IV initially then 100 mg IV every 12 hours

ORAL:

• Less than 45 kg: 2.2 mg/kg orally every 12 hours
• At least 45 kg: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days after exposure

Systemic/severe anthrax when meningitis has been excluded:

• Term neonate (younger than 1 month): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
• Children 1 month or older: At least 14 days or until patient is clinically stable (whichever is longer)
• Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:

• Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
• Naturally-acquired cases: 7 to 10 days

Follow-up for severe anthrax:

• Term neonate (younger than 1 month): To complete a regimen of at least 10 to 14 days
• Children 1 month or older: To complete a regimen of at least 14 days
• Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:

• Recommended for postexposure prophylaxis as a preferred oral drug in children 1 month or older and as an alternative oral drug for term neonates (younger than 1 month)
• Recommended as an alternative oral drug for the treatment of cutaneous anthrax without systemic involvement
• Recommended as an alternative protein synthesis inhibitor for the IV treatment of systemic/severe anthrax when meningitis has been excluded and for oral follow-up for severe anthrax
• Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
• Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Anthrax Prophylaxis

Less than 45 kg:

• Most products: 2.2 mg/kg orally or IV twice a day
• Alternatively, Doryx(R) MPC: 2.6 mg/kg orally twice a day

At least 45 kg:

• Most products: 100 mg orally or IV twice a day
• Alternatively, Doryx(R) MPC: 120 mg orally twice a day

Duration of therapy: 60 days

Comments:

• Parenteral therapy is recommended only when oral therapy is not indicated and should not be continued over an extended period.
• Oral therapy should be started as soon as possible.
• Treatment duration of 60 days includes any parenteral therapy plus oral therapy.

Use: For the treatment of anthrax due to B anthracis (including inhalational anthrax [postexposure]) to reduce the incidence or progression of disease after exposure to aerosolized B anthracis

AAP Recommendations:
Term neonate (younger than 1 month): 4.4 mg/kg orally or IV initially then 2.2 mg/kg orally or IV every 12 hours

Children 1 month or older:
IV:

• Less than 45 kg: 4.4 mg/kg IV initially then 2.2 mg/kg IV every 12 hours
• At least 45 kg: 200 mg IV initially then 100 mg IV every 12 hours

ORAL:

• Less than 45 kg: 2.2 mg/kg orally every 12 hours
• At least 45 kg: 100 mg orally every 12 hours

Duration of Therapy:
Postexposure prophylaxis for B anthracis infection: 60 days after exposure

Systemic/severe anthrax when meningitis has been excluded:

• Term neonate (younger than 1 month): At least 2 to 3 weeks or until patient is clinically stable (whichever is longer)
• Children 1 month or older: At least 14 days or until patient is clinically stable (whichever is longer)
• Patients will require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Cutaneous anthrax without systemic involvement:

• Bioterrorism-related cases: To complete an antimicrobial regimen of up to 60 days from onset of illness
• Naturally-acquired cases: 7 to 10 days

Follow-up for severe anthrax:

• Term neonate (younger than 1 month): To complete a regimen of at least 10 to 14 days
• Children 1 month or older: To complete a regimen of at least 14 days
• Patients may require prophylaxis to complete an antimicrobial regimen of up to 60 days from onset of illness.

Comments:

• Recommended for postexposure prophylaxis as a preferred oral drug in children 1 month or older and as an alternative oral drug for term neonates (younger than 1 month)
• Recommended as an alternative oral drug for the treatment of cutaneous anthrax without systemic involvement
• Recommended as an alternative protein synthesis inhibitor for the IV treatment of systemic/severe anthrax when meningitis has been excluded and for oral follow-up for severe anthrax
• Recommended for all strains (regardless of penicillin susceptibility or if susceptibility unknown) when used for postexposure prophylaxis or cutaneous anthrax without systemic involvement
• Systemic/severe anthrax includes anthrax meningitis, inhalation anthrax, injection anthrax, gastrointestinal anthrax, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Mycoplasma Pneumonia

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of respiratory tract infections due to M pneumoniae
• For the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to S pneumoniae when bacteriological testing shows suitable susceptibility to this drug

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:

• Older than 7 years: 1 to 2 mg/kg orally twice a day

Comments:

• Recommended as an alternative for step-down therapy or mild infection due to M pneumoniae, C trachomatis, or C pneumoniae
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Pneumonia

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of respiratory tract infections due to M pneumoniae
• For the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to S pneumoniae when bacteriological testing shows suitable susceptibility to this drug

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:

• Older than 7 years: 1 to 2 mg/kg orally twice a day

Comments:

• Recommended as an alternative for step-down therapy or mild infection due to M pneumoniae, C trachomatis, or C pneumoniae
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Upper Respiratory Tract Infection

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of respiratory tract infections due to M pneumoniae
• For the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to S pneumoniae when bacteriological testing shows suitable susceptibility to this drug

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:

• Older than 7 years: 1 to 2 mg/kg orally twice a day

Comments:

• Recommended as an alternative for step-down therapy or mild infection due to M pneumoniae, C trachomatis, or C pneumoniae
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Bronchitis

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).
• When used in streptococcal infections, duration of therapy should be 10 days.

Uses:

• For the treatment of respiratory tract infections due to M pneumoniae
• For the treatment of respiratory tract infections due to H influenzae or Klebsiella species and upper respiratory infections due to S pneumoniae when bacteriological testing shows suitable susceptibility to this drug

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:

• Older than 7 years: 1 to 2 mg/kg orally twice a day

Comments:

• Recommended as an alternative for step-down therapy or mild infection due to M pneumoniae, C trachomatis, or C pneumoniae
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Rickettsial Infection

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Uses: For the treatment of rickettsial infections including RMSF, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species

US CDC and AAP Recommendations:

• Less than 45 kg: 2.2 mg/kg orally or IV twice a day
• At least 45 kg: 100 mg orally or IV twice a day

Duration of Therapy:

• RMSF, ehrlichiosis: At least 3 days after fever subsides and until evidence of clinical improvement
• Anaplasmosis: 10 days

Comments:

• Recommended as drug of choice for all tickborne rickettsial diseases; recommended for patients of all ages
• Tickborne rickettsial diseases include RMSF due to R rickettsii, other spotted fever group rickettsioses due to R parkeri and Rickettsia species 364D, E chaffeensis ehrlichiosis (i.e., human monocytic ehrlichiosis), other ehrlichioses due to E ewingii and E muris-like agent, and anaplasmosis due to A phagocytophilum (i.e., human granulocytic anaplasmosis).
• The usual minimum duration of therapy for RMSF and ehrlichiosis is 5 to 7 days (total); severe/complicated disease may require longer therapy.
• According to some experts, typical duration of therapy for ehrlichiosis is 7 to 14 days.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Q Fever

IV:
Less than 45 kg:
All patients with severe or life-threatening infections (e.g., RMSF): 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Uses: For the treatment of rickettsial infections including RMSF, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers due to Rickettsia species

US CDC and AAP Recommendations:

• Less than 45 kg: 2.2 mg/kg orally or IV twice a day
• At least 45 kg: 100 mg orally or IV twice a day

Duration of Therapy:

• RMSF, ehrlichiosis: At least 3 days after fever subsides and until evidence of clinical improvement
• Anaplasmosis: 10 days

Comments:

• Recommended as drug of choice for all tickborne rickettsial diseases; recommended for patients of all ages
• Tickborne rickettsial diseases include RMSF due to R rickettsii, other spotted fever group rickettsioses due to R parkeri and Rickettsia species 364D, E chaffeensis ehrlichiosis (i.e., human monocytic ehrlichiosis), other ehrlichioses due to E ewingii and E muris-like agent, and anaplasmosis due to A phagocytophilum (i.e., human granulocytic anaplasmosis).
• The usual minimum duration of therapy for RMSF and ehrlichiosis is 5 to 7 days (total); severe/complicated disease may require longer therapy.
• According to some experts, typical duration of therapy for ehrlichiosis is 7 to 14 days.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Cholera

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of cholera due to V cholerae

PAHO Recommendations: 2 to 4 mg/kg orally once

Comments:

• Recommended as alternative agent for the treatment of cholera in infants and children
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Granuloma Inguinale

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Uses:

• For the treatment of granuloma inguinale due to K granulomatis
• For the treatment of lymphogranuloma venereum due to C trachomatis

AAP Recommendations:
8 years or older: 100 mg orally twice a day

Duration of Therapy:

• Granuloma inguinale: At least 3 weeks and until all lesions have completely healed
• Lymphogranuloma venereum: 21 days

Comments:

• Recommended as the drug of choice for granuloma inguinale; gentamicin may be added if no improvement is observed after several days.
• Recommended as the preferred therapy for lymphogranuloma venereum
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lymphogranuloma Venereum

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Uses:

• For the treatment of granuloma inguinale due to K granulomatis
• For the treatment of lymphogranuloma venereum due to C trachomatis

AAP Recommendations:
8 years or older: 100 mg orally twice a day

Duration of Therapy:

• Granuloma inguinale: At least 3 weeks and until all lesions have completely healed
• Lymphogranuloma venereum: 21 days

Comments:

• Recommended as the drug of choice for granuloma inguinale; gentamicin may be added if no improvement is observed after several days.
• Recommended as the preferred therapy for lymphogranuloma venereum
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Malaria Prophylaxis

8 years or older:
Most products: 2 mg/kg orally once a day
Maximum dose: 100 mg/dose

Doryx(R) MPC: 2.4 mg/kg orally once a day

• At least 45 kg: 120 mg orally once a day

Comments:

• Prophylaxis should start 1 to 2 days before travel to endemic area; should continue daily while in malarious areas and for 4 weeks after leaving such areas
• Prophylaxis with this drug should not exceed 4 months.
• According to some manufacturers, patients weighing at least 45 kg should receive the adult dose.

Use: For prophylaxis of malaria due to P falciparum in short-term travelers (less than 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

US CDC Recommendations:
8 years or older: 2.2 mg/kg orally once a day
Maximum dose: 100 mg/dose

Comments:

• Recommended for prophylaxis in all areas
• Not recommended for use during pregnancy or in patients younger than 8 years.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Malaria

US CDC Recommendations:
8 years or older:
Uncomplicated malaria: 2.2 mg/kg orally every 12 hours for 7 days
Maximum dose: 100 mg/dose

Severe malaria:

• Less than 45 kg: 2.2 mg/kg orally or IV every 12 hours
• At least 45 kg: 100 mg orally or IV twice a day

Duration of therapy: 7 days

Comments:

• With quinine, recommended for uncomplicated malaria due to chloroquine-resistant P falciparum
• With quinine and primaquine, recommended for uncomplicated malaria due to chloroquine-resistant P vivax
• With quinine, recommended for severe malaria
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Plague

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of plague due to Y pestis

US CDC Recommendations:

• Less than 45 kg: 2.2 mg/kg orally or IV twice a day
• At least 45 kg: 100 mg orally or IV twice a day or 200 mg orally or IV once a day

Duration of therapy: 10 to 14 days (or until 2 days after fever subsides)

Comments:

• In general, recommended as an alternative regimen for the treatment of plague
• IV therapy should be started as soon as plague suspected; may switch to oral therapy once patient improves
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Plague Prophylaxis

US CDC Recommendations:
8 years or older:

• Less than 45 kg: 2.2 mg/kg orally twice a day
• At least 45 kg: 100 mg orally twice a day

Duration of therapy: 7 days

Comments:

• Recommended as a preferred agent for postexposure prophylaxis in patients with known exposure to plague (e.g., close contact with pneumonic plague patient, direct contact with infected body fluids/tissues)
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Tularemia

IV:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

ORAL:
Most Products:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.2 mg/kg orally once a day or 1.1 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 200 mg orally on the first day, given in 2 divided doses (100 mg every 12 hours)
• Maintenance dose: 100 mg orally once a day OR 50 mg orally every 12 hours
• More severe infections: 100 mg orally every 12 hours

Doryx(R) MPC:
Less than 45 kg:
All patients with severe or life-threatening infections: 2.6 mg/kg orally every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 5.3 mg/kg orally on the first day, given in 2 divided doses
• Maintenance dose: 2.6 mg/kg orally once a day or 1.3 mg/kg orally twice a day

At least 45 kg:

• Initial dose: 240 mg orally on the first day, given in 2 divided doses (120 mg every 12 hours)
• Maintenance dose: 120 mg orally once a day or 60 mg orally every 12 hours
• More severe infections: 120 mg orally every 12 hours

Comments:

• The IV maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• For patients at least 45 kg using a monohydrate formulation, the initial oral dose may be given in 2 or 4 divided doses (100 mg every 12 hours or 50 mg every 6 hours).

Use: For the treatment of tularemia due to F tularensis

Working Group on Civilian Biodefense Recommendations:

• Less than 45 kg: 2.2 mg/kg orally or IV twice a day
• At least 45 kg: 100 mg orally or IV twice a day

Duration of Therapy:

• Postexposure prophylaxis: 14 days
• Treatment in a contained casualty setting: At least 14 days
• Treatment in a mass casualty setting: 14 to 21 days

Comments:

• Recommended as an alternative IV regimen for the treatment of tularemia in a contained casualty setting and for postexposure prophylaxis
• Recommended as a preferred oral regimen for the treatment of tularemia in a mass casualty setting and for postexposure prophylaxis
• If parenteral therapy is used initially, may switch to oral therapy when clinically indicated
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Skin or Soft Tissue Infection

Less than 45 kg:
All patients with severe or life-threatening infections: 2.2 mg/kg IV every 12 hours

Patients older than 8 years with less severe infections:

• Initial dose: 4.4 mg/kg IV on the first day, given in 2 infusions
• Maintenance dose: 2.2 mg/kg IV once a day or 1.1 mg/kg IV twice a day

At least 45 kg:

• Initial dose: 200 mg IV on the first day, given in 1 or 2 infusions
• Maintenance dose: 100 to 200 mg/day IV

Comments:

• The maintenance dose for patients weighing at least 45 kg depends on the severity of the infection; the 200 mg dose may be given in 1 or 2 infusions.
• Not the drug of choice for any type of staphylococcal infection

Use: For the treatment of skin and soft tissue infections due to S aureus when bacteriological testing shows suitable susceptibility to this drug

IDSA Recommendations:
8 years or older:

• Up to 45 kg: 2 mg/kg orally every 12 hours
• Greater than 45 kg: 100 mg orally twice a day

Comments:

• Recommended for purulent cellulitis (cellulitis associated with purulent drainage/exudate without a drainable abscess) due to methicillin-resistant S aureus
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Nongonococcal Urethritis

AAP Recommendations:

• Adolescents and children 8 years or older weighing at least 45 kg: 100 mg orally twice a day for 7 days

Comments:

• Recommended in combination with ceftriaxone
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Cervicitis

AAP Recommendations:

• Adolescents and children 8 years or older weighing at least 45 kg: 100 mg orally twice a day for 7 days

Comments:

• Recommended in combination with ceftriaxone
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Chlamydia Infection

AAP and US CDC Recommendations:
Adolescents and children 8 years or older: 100 mg orally twice a day for 7 days

• Alternatively for adolescents (delayed-release tablets): 200 mg orally once a day for 7 days

Comments:

• Recommended for uncomplicated anogenital tract infection due to C trachomatis
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Epididymitis - Sexually Transmitted

AAP and US CDC Recommendations:

• Adolescents: 100 mg orally twice a day for 10 days

Comments:

• With ceftriaxone, the recommended regimen for acute epididymitis most likely due to sexually transmitted chlamydia and gonorrhea
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Gonococcal Infection - Uncomplicated

US CDC Recommendations:

• Adolescents: 100 mg orally twice a day for 7 days

Comments:

• With ceftriaxone (or cefixime), recommended for uncomplicated infections of the cervix, urethra, or rectum as an alternative second antimicrobial in patients with azithromycin allergy
• The AAP recommends the same dose for patients 8 years or older weighing at least 45 kg.
• The patient's sexual partner(s) should also be evaluated/treated.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease - Arthritis

IDSA Recommendations:
8 years or older: 2 mg/kg orally twice a day
Maximum dose: 100 mg/dose

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease - Carditis

IDSA Recommendations:
8 years or older: 2 mg/kg orally twice a day
Maximum dose: 100 mg/dose

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease - Erythema Chronicum Migrans

IDSA Recommendations:
8 years or older: 2 mg/kg orally twice a day
Maximum dose: 100 mg/dose

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease

IDSA Recommendations:
8 years or older: 2 mg/kg orally twice a day
Maximum dose: 100 mg/dose

Duration of Therapy:

• Acrodermatitis chronica atrophicans: 21 days
• Cardiac disease: 14 to 21 days
• Erythema migrans: 10 to 21 days
• Lyme arthritis: 28 days

Comments:

• Recommended for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans when specific neurologic manifestations or advanced atrioventricular heart block absent, uncomplicated Lyme arthritis in patients without clinical evidence of neurologic disease, patients with atrioventricular heart block and/or myopericarditis associated with early Lyme disease, and acrodermatitis chronica atrophicans
• A parenteral antibiotic (e.g., ceftriaxone) is recommended as initial treatment of patients hospitalized for cardiac monitoring; an oral regimen may be used for completion of therapy and for ambulatory patients.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Lyme Disease - Neurologic

IDSA Recommendations:
8 years or older: 2 to 4 mg/kg orally twice a day
Maximum dose: 200 mg/dose
Duration of therapy: 14 days (range: 10 to 28 days)

Comments:

• Recommended as the preferred regimen for the treatment of nervous system Lyme disease (including the following syndromes: meningitis, any neurologic syndrome with CSF pleocytosis, peripheral nerve [radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF])
• Recommended in early Lyme disease for patients intolerant of beta-lactam antibiotics with acute neurologic disease manifested by meningitis or radiculopathy
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Pelvic Inflammatory Disease

US CDC Recommendations:

• Adolescents: 100 mg orally or IV every 12 hours

Duration of therapy: 14 days

Comments:

• With other agents, recommended as part of a parenteral regimen or as part of an IM/oral regimen; also recommended as part of an alternative parenteral regimen
• This drug may be switched from IV to oral administration 24 to 48 hours after clinical improvement to complete 14 days of therapy.
• Current guidelines should be consulted for additional information.

Usual Pediatric Dose for STD Prophylaxis

AAP Recommendations:
8 years or older and not pregnant: 100 mg orally twice a day for 7 days

Comments:

• With ceftriaxone, recommended as prophylaxis after sexual assault for dual therapy for gonorrhea and chlamydia
• Current guidelines should be consulted for additional information.

Renal Dose Adjustments

Most formulations: No adjustment recommended.
40 mg capsule formulation: May need to adjust dose; however, no specific guidelines have been suggested.

Liver Dose Adjustments

Data not available

Precautions

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Comments:

• Dialysis does not alter the serum half-life of this drug.

Other Comments

Administration advice:

• Avoid rapid IV administration; infusion duration may vary with dose, but is generally 1 to 4 hours; infuse 100 mg dose (of a 0.5 mg/mL solution) over at least 1 hour.
• Do not inject IV solutions IM or subcutaneously; use caution to avoid extravasation.
• Only use IV therapy short-term when oral therapy is not indicated; switch to oral therapy as soon as clinically feasible.
• Continue therapy for at least 24 to 48 hours after symptoms/fever subside.
• Administer oral formulations with plenty of fluid in an upright position to reduce the risk of esophageal irritation and ulceration.
• For most oral products, administer with food or milk if gastric irritation occurs; absorption not significantly affected by food or milk.
• May carefully break up a delayed-release tablet and sprinkle the contents (delayed-release pellets) on a spoonful of applesauce (to be swallowed at once without chewing); do not crush or damage delayed-release pellets when breaking up the tablet.
• Do not chew or crush Doryx(R) MPC tablets; this product is not substitutable on a mg per mg basis with other oral products.
• According to some manufacturers: Swallow capsules whole; do not break, open, crush, dissolve, or chew.
• Administer the 40 mg capsule formulation and the 20 mg capsule/tablet formulation on an empty stomach, 1 hour before or 2 hours after a meal.

Storage requirements:

• IV: The manufacturer product information should be consulted regarding storage and stability of reconstituted and/or further diluted solutions; protect solution from direct sunlight and/or artificial light.
• Oral formulations: Store below 30C (86F); protect from light.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.
• IV: Reconstitution and further dilution needed, resulting in concentrations of 0.1 to 1 mg/mL; concentrations below 0.1 mg/mL or above 1 mg/mL are not recommended.

IV compatibility:

• Compatible: Sterile Water for Injection; Sodium Chloride Injection, USP; 5% Dextrose Injection, USP; Ringers Injection, USP; Invert Sugar, 10% in Water; Lactated Ringers Injection, USP; Dextrose 5% in Lactated Ringers; Normosol-M(R) in D5-W (5% dextrose in water) (Abbott); Normosol-R(R) in D5-W (Abbott); Plasma-Lyte(R) 56 in 5%Dextrose (Travenol); Plasma-Lyte(R) 148 in 5% Dextrose (Travenol)

General:

• The usual dose and dosing frequency of this drug are different from other tetracyclines; side effects may occur more often if recommended dose exceeded.
• Therapeutic antibacterial serum activity generally persists 24 hours after recommended dose.
• Thrombophlebitis may occur if IV therapy prolonged.
• Incision and drainage or other surgical procedures may be indicated in addition to antibiotic therapy.
• Absorption of tetracyclines impaired by iron-, zinc-, calcium-, aluminum-, or magnesium-containing products (e.g., antacids, sucralfate, mineral supplements, buffered didanosine).
• If the oral suspension is not available, emergency doses may be prepared from the tablets. The US FDA website should be consulted for information regarding preparation of this drug for patients who cannot swallow tablets (only recommended during a declared emergency).
• The 40 mg capsule formulation has not been evaluated for treatment or prevention of infections; it should not be used for treatment of bacterial infection, antibacterial prophylaxis, or reduction/elimination of microorganisms associated with any bacterial infection.

Monitoring:

• General: Organ system studies (periodically during long-term therapy)
• Hematologic: Hematopoietic studies (periodically during long-term therapy)
• Hepatic: Hepatic studies (periodically during long-term therapy)
• Renal: Renal studies (periodically during long-term therapy)

Patient advice:

• Read the US FDA-approved patient labeling (Patient Information), if applicable.
• Drink plenty of fluids.
• Avoid missing doses and complete the entire course of therapy.
• Avoid or minimize exposure to natural or artificial sunlight; use sun protection (e.g., protective clothing, sunscreen) if sun exposure cannot be avoided. Stop therapy if phototoxicity occurs.
• Consult physician at once if watery and bloody stools (with or without stomach cramps and fever) develop.
• Do not use this drug if it is outdated or decomposed; discard this drug by the expiration date.

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Further information

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