Doxycycline hyclate indications and usage

# Indications and Usage
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Doxycycline for Injection, USP and other antibacterial drugs, Doxycycline for Injection, USP should be used only to treat or prevent infections that are caused by susceptible bacteria.  When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy.  In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Doxycycline for Injection, USP is indicated in infections caused by the following microorganisms:
- Rickettsiae (Rocky Mountain spotted fever, typhus fever, and the typhus group, Q fever, rickettsial pox and tick fevers).
- Mycoplasma pneumoniae (PPLO, Eaton Agent).
- Agents of psittacosis and ornithosis.
- Agents of lymphogranuloma venereum and granuloma inguinale.
- The spirochetal agent of relapsing fever (Borelia recurrentis).
The following gram-negative microorganisms:
- Haemophilus ducreyi (chancroid).
- Pasteurella pestis and Pasteurella tularensis.
- Bartonella bacilliformis.
- Bacteroides species.
- Vibrio comma and Vibrio fetus.
- Brucella species (in conjunction with streptomycin).
Because many strains of the following groups of microorganisms have been shown to be resistant to tetracyclines, culture and susceptibility testing are recommended.
Doxycycline is indicated for treatment of infections caused by the following gram-negative microorganisms when bacteriologic testing indicates appropriate susceptibility to the drug:
- Escherichia coli.
- Enterobacter aerogenes (formerly Aerobacter aerogenes).
- Shigella species.
- Mima species and Herellea species.
- Haemophilus influenzae (respiratory infections).
- Klebsiella species (respiratory and urinary infections).
Doxycycline is indicated for treatment of infections caused by the following gram-positive microorganisms when bacteriologic testing indicates appropriate susceptibility to the drug:
- Anthrax due to Bacillus anthracis, including inhalational anthrax (post-exposure): to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis.
- Streptococcus species:
Up to 44% of strains of Streptococcus pyogenes and 74% of Streptococcus faecalis have been found to be resistant to tetracycline drugs.  Therefore, tetracyclines should not be used for streptococcal disease unless the organism has been demonstrated to be sensitive.
For upper respiratory infections due to group A beta-hemolytic streptococci, penicillin is the usual drug of choice, including prophylaxis of rheumatic fever.
- Diplococcus pneumoniae.
- Staphylococcus aureus, respiratory, skin and soft tissue infections.  Tetracyclines are not the drugs of choice in the treatment of any type of staphylococcal infections.
When penicillin is contraindicated, doxycycline is an alternative drug in the treatment of infections due to:
- Neisseria gonorrhoeae and N. meningitidis.
- Treponema pallidum and Treponema pertenue (syphilis and yaws).
- Listeria monocytogenes.
- Clostridium species.
- Fusobacterium fusiforme (Vincents infection).
- Actinomyces species.
In acute intestinal amebiasis, doxycycline may be a useful adjunct to amebicides.
Doxycycline is indicated in the treatment of trachoma, although the infectious agent is not always eliminated, as judged by immunofluorescence.