1 May 2026Oral drugsSource update: September 2023
Doxycycline oral
Doxycycline guidance for a broad range of bacterial and parasitic infections, including plague, rickettsioses, syphilis, and leptospirosis.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
Therapeutic action
Cycline antibacterial.
Indications
In children under 8 years, doxycycline can be used in treatments no longer than 21 days.
- Cholera, uncomplicated cutaneous anthrax, louse-borne and tick-borne relapsing fevers, epidemic typhus, and other rickettsioses, plague, brucellosis, leptospirosis, and lymphogranuloma venereum.
- Lymphatic filariasis and as an alternative to ivermectin in onchocerciasis.
- Alternative to first-line treatments of treponematosis, atypical pneumonia, cervicitis and urethritis due to Chlamydia trachomatis, donovanosis, and syphilis.
Forms and strengths
- 100 mg tablet.
Dose
Louse-borne relapsing fever, epidemic typhus, cholera
- Child: 4 mg/kg, maximum 100 mg, single dose.
- Adult: 200 mg single dose, or 300 mg in cholera.
Plague
- Child under 45 kg: 4.4 mg/kg, maximum 200 mg, on D1 then 2.2 mg/kg, maximum 100 mg, 2 times daily.
- Child 45 kg and over and adult: 200 mg on D1 then 100 mg 2 times daily.
Other indications
- Child under 45 kg: 2 to 2.2 mg/kg, maximum 100 mg, 2 times daily.
- Child 45 kg and over and adult: 100 mg 2 times daily.
- In severe infections, a loading dose as for plague is recommended.
Duration
- Rickettsiosis: 5 to 7 days or until 3 days after fever has disappeared.
- Leptospirosis, cervicitis and urethritis due to C. trachomatis: 7 days.
- Cutaneous anthrax and tick-borne relapsing fever: 7 to 10 days.
- Plague and atypical pneumonia: 10 to 14 days.
- Early syphilis, bejel, pinta, and lymphogranuloma: 14 days.
- Filariasis: minimum 4 weeks.
- Late latent syphilis: 30 days.
- Brucellosis: 6 weeks.
- Donovanosis: until complete healing of lesions.
Contra-indications, adverse effects, precautions
- Do not administer to patients with allergy to cyclines.
- Do not administer treatments longer than 21 days in children under 8 years because of the risk of tooth discoloration.
- Administer with caution to patients with hepatic or renal impairment.
- May cause gastrointestinal disturbances, allergic reactions, photosensitivity, and oesophageal ulcerations. Take tablets during meals with a glass of water in an upright position and at least 1 hour before going to bed.
- Do not give simultaneously with ferrous salts, zinc sulfate, calcium carbonate, or antacids; administer 2 hours apart.
- Monitor combination with hepatic enzyme inducers such as rifampicin, phenobarbital, phenytoin, and carbamazepine because doxycycline efficacy is reduced.
- Pregnancy: avoid during the 2nd and 3rd trimester except in severe infections when benefits outweigh risks.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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