Doxycycline

STI Standards

Midwives may independently prescribe, order, and administer drugs in the community, hospital or other sites of midwifery practice to treat sexually transmitted infections for clients in case, as designated under specialized practice certification. Midwives without specialized practice certification in sexually transmitted infections management are required to refer their clients to an appropriate health care practitioner for treatment. 

Doxycycline is a broad spectrum semisynthetic tetracycline antibiotic. Inhibits protein synthesis by binding with the 30S and possibly 50S ribosomal subunits of susceptible bacteria. May also cause cytoplasmic membrane alterations.

Indications and Clinical Use:

For treatment of asymptomatic or symptomatic chlamydia trachomatis and neisseria gonorrhea and uncomplicated sexually transmitted infections.

Contraindications:

Documented hypersensitivity or allergy to doxycycline, tetracycline or any other component of the formulation; severe renal or hepatic dysfunction; myasthenia gravis. Contraindicated in pregnancy specifically during 2nd and 3rd trimesters.

Warnings and Precautions:

Reduces efficacy of oral contraceptives; may enhance chance of candidiasis; to be used with caution in individuals with asthma, allergies, hay fever and/or urticaria.

Breastfed infants should be monitored for vomiting, diarrhea, changes in bowel flora and/or rash; prolonged exposure may lead to decreased bone growth and dental staining.

Pregnancy:

Tetracyclines cross the placenta and accumulate in developing teeth and bones; can cause maternal liver toxicity and congenital defects.

Lactation:

Limited Data – Probably Compatible
Doxycycline is the least of the tetracyclines to be bound to calcium when secreted into milk and may be better absorbed in a breastfeeding infant. Short term use (3-4 wks) is not contraindicated although its use should be limited to cases where other antibiotic options are unavailable. No harmful effects have been reported.

Adverse Reactions:

Upset stomach, diarrhea, vomiting, vaginal monilial overgrowth and/or skin rash. The following should be reported to a medical practitioner immediately: severe skin rash, itching, hives, difficulty breathing or swallowing, wheezing, unusual bleeding or bruising, sore throat, painful mouth or throat sores, jaundice and/or diarrhea.

Dosage and Administration:

Chlamydia Trachomatis:
Doxycycline: 100 mg orally every 12 hours (bid) for 7 days If the client has missed 2 consecutive doses of doxycycline within the first 5 days of treatment, or has not completed a full five consecutive days of treatment, (Doxycycline at 100 mg po bid) then retreatment is indicated.

Neisseria Gonorrhea:
Doxycycline – if not pregnant: 100 mg orally every 12 hours (bid) for 7 days.

Onset of Action:

Oral: Administration on an empty stomach is not recommended.
Antacids may slow absorption of Doxycycline. Should be taken with a full glass of water.

Duration of Action:

Peak serum concentrations usually attained within 1.5-4 hours.
Half-life: 12-22 hours.