- Doxycycline is the most commonly used antibiotic
for Lyme disease.
It's a easy-to-take twice a day pill
oral antibiotic.
And the unique features of doxycycline are that it's
an antibiotic that's actually effective for
not just Lyme disease but many of the tick-borne infections,
such as anaplasmosis, ehrlichiosis,
and Rocky Mountain spotted fever.
Doxycycline shouldn't necessarily be used in children
under the age of eight, but for adults,
doxycycline would be our first line therapy.
Doxycycline is used in three major scenarios
when a clinician is considering tick-borne diseases.
The first scenario is when we have a firm diagnosis
of Lyme disease, or anaplasmosis,
or Rocky Mountain spotted fever.
The second scenario is when we have a high risk situation
where it's a Lyme or tick-borne disease endemic region
of the United States, it's the right season of the year.
And so we know there's a high likelihood of a tick-borne
infection, but we don't yet have a firm, final diagnosis.
This is called empiric therapy,
and in this scenario, we often go to doxycycline
when the risk of a tick-borne infection is high.
The third scenario would be in life-threatening situations
where we suspect a life-threatening infection,
like Rocky Mountain spotted fever.
It's a unique antibiotic in it's impact on bacteria
and its ability to stop the growth of bacteria,
but it's also unique in it's impact on the human
immune system and its ability to act
as an anti-inflammatory.
In order to improve the effectiveness of doxycycline,
we wanna make sure that all the pills
are absorbed when they're ingested
into the stomach and bowels.
And the one potential inhibitor of absorption
is calcium.
So, taking doxycycline is very important to try
to minimize calcium intake, especially in the form of
calcium vitamins or Tums
or foods that are high in calcium such as dairy products.
And in general, we recommend not taking dairy products
or milk or calcium vitamins within an hour or two
before or after you take doxycycline.
The impact of calcium on the absorption is
mild, but may be as high as a 20% inhibition
of absorption of the doxycycline medication.
We recommend people try to take doxycycline
on an empty stomach.
In some people, I've heard this will cause
stomach upset, and so if that happens,
it is okay to take doxycycline with foods.
Just again, avoid foods like dairy or yogurt
that are high in calcium.
The most common side effect of doxycycline is
called esophagitis, that's irritation or ulceration
of the food pipe, the esophagus that goes from
the mouth to the stomach.
Doxycycline is particularly irritating for the food pipe,
the esophagus, and so we always wanna make sure
that the pills are completely washed down
into your stomach.
Always take doxycycline with a large glass of water.
And then we advise not laying down for at least an hour
after you take doxycycline.
This will make sure that the doxycycline gets down
into the stomach and stays in the stomach.
If doxycycline causes irritation or ulceration
of the esophagus, it presents with symptoms of
pain with swallowing or pain in the chest.
That's an indication that there could be an ulcer forming,
and that's a potentially serious complication
of doxycycline.
Again, we try to avoid that at all costs by taking
doxy with a large glass of water
and then not lying down afterwards.
If you develop, however, pain in the esophagus
or pain with swallowing in the chest while you're taking
doxycycline, you should stop the medication
and call your physician for advice.
The second major side effect of doxycycline
is sun sensitivity.
Doxycycline causes an enhanced reaction to sun
and an enhanced sunburn in some people.
Doesn't happen in everyone, but when it happens,
it's an unpleasant sunburn-like sensation.
Some people describe it as almost a sense of a burning
or like oil was poured on their skin.
And people can get rashes from sun sensitivity
and sunburn in unusual places.
For instance, the back of the hand or the top of the feet
when you're wearing sandals.
People should be aware of this
and take appropriate precautions.
Wear long-sleeved shirts, and cover up as much skin
as is practical and possible.
And then use a very high SPF containing sunscreen
on areas of your skin that you can't cover up.
For instance, the face, the nose, the ears,
the top of the hands.
There are rare serious side effects from doxycycline,
as in any antibiotic.
You can get an allergic, true allergic reaction
to doxycycline.
And the risk factors for this to be aware of
is the development of a generalized skin rash.
Not one that is just in sun-exposed areas,
but a generalized rash.
And especially any rashes accompanied by
systemic symptoms such as a new fever or headache
or other signs of a generalized drug reaction.
Those are the indications to stop the drug
and call your physician.
Another very rare, uncommon side effect of doxycycline
is the development of severe headaches.
This is a rare condition called pseudotumor cerebri.
These are headaches that may be accompanied by
visual loss or blindness,
and extreme nausea and vomiting.
And this is a serious, fortunately rare,
but very serious side effect.
That again, severe headache accompanied by visual changes
should prompt stopping the doxycycline
and contacting your physician immediately.
Doxycycline is usually prescribed between 14 and 21 days
of therapy.
It's a twice a day pill antibiotic,
so it should be spaced apart approximately 12 hours.
Of course, as with all antibiotics, care should be taken
not to miss doses.
If a dose is missed and it's only with a few hours off,
it's okay to take the doxycycline a few hours late.
If a complete dose is missed then the advice would be
to then just pick up the next dose at the 12 hour interval
that comes next.
As in all antibiotics, you should complete the entire
prescription of doxycycline.
Don't stop the doxycycline just because
you're feeling better.
Complete the entire course of therapy,
and then follow up with your physician about your
response to the therapy.