Editing Doxycycline (section)

== Medical uses ==
[[File:Doxycycline 100mg capsules.jpg|right|thumb|Generic 100&nbsp;mg doxycycline capsules]] [[File:Doksiciklin 100 091208.jpg|right|thumb|A package of generic doxycycline]]
In addition to the general indications for all members of the [[tetracycline antibiotics]] group, doxycycline is frequently used to treat [[Lyme disease]], chronic [[prostatitis]], [[sinusitis]], [[pelvic inflammatory disease]],<ref name="pmid3162653">{{cite journal | vauthors = Sweet RL, Schachter J, Landers DV, Ohm-Smith M, Robbie MO | title = Treatment of hospitalized patients with acute pelvic inflammatory disease: comparison of cefotetan plus doxycycline and cefoxitin plus doxycycline | journal = American Journal of Obstetrics and Gynecology | volume = 158 | issue = 3 Pt 2 | pages = 736–41 | date = March 1988 | pmid = 3162653 | doi = 10.1016/S0002-9378(16)44537-0 }}</ref><ref name="pmid345730">{{cite journal | vauthors = Gjønnaess H, Holten E | title = Doxycycline (Vibramycin) in pelvic inflammatory disease | journal = Acta Obstetricia et Gynecologica Scandinavica | volume = 57 | issue = 2 | pages = 137–9 | year = 1978 | pmid = 345730 | doi = 10.3109/00016347809155893 | s2cid = 28328073 }}</ref> severe [[Acne vulgaris|acne]], [[rosacea]],<ref name="safety-2009">{{Cite journal|title=Safety and Efficacy Review of Doxycycline| vauthors = Holmes NE, Charles PG |date=5 January 2009|journal=Clinical Medicine. Therapeutics|volume=1|pages=CMT.S2035|doi=10.4137/CMT.S2035|s2cid=58790579 }}</ref><ref name="pmid16411105">{{cite journal | vauthors = Määttä M, Kari O, Tervahartiala T, Peltonen S, Kari M, Saari M, Sorsa T | title = Tear fluid levels of MMP-8 are elevated in ocular rosacea--treatment effect of oral doxycycline | journal = Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht von Graefes Archiv für Klinische und Experimentelle Ophthalmologie | volume = 244 | issue = 8 | pages = 957–62 | date = August 2006 | pmid = 16411105 | doi = 10.1007/s00417-005-0212-3 | s2cid = 20540747 }}</ref><ref name="pmid9006372">{{cite journal | vauthors = Quarterman MJ, Johnson DW, Abele DC, Lesher JL, Hull DS, Davis LS | title = Ocular rosacea. Signs, symptoms, and tear studies before and after treatment with doxycycline | journal = Archives of Dermatology | volume = 133 | issue = 1 | pages = 49–54 | date = January 1997 | pmid = 9006372 | doi = 10.1001/archderm.133.1.49 }}</ref> and [[rickettsial]] infections.<ref name="pmid19061755">{{cite journal | vauthors = Walker DH, Paddock CD, Dumler JS | title = Emerging and re-emerging tick-transmitted rickettsial and ehrlichial infections | journal = The Medical Clinics of North America | volume = 92 | issue = 6 | pages = 1345–61, x | date = November 2008 | pmid = 19061755 | doi = 10.1016/j.mcna.2008.06.002 }}</ref> The efficiency of oral doxycycline for treating papulopustular rosacea and adult acne is not solely based on its antibiotic properties, but also on its anti-inflammatory and [[anti-angiogenic]] properties.<ref name="pmid38649625"/>

In Canada, in 2004, doxycycline was considered a first-line treatment for [[chlamydia]] and [[non-gonococcal urethritis]] and with [[cefixime]] for uncomplicated [[gonorrhea]].<ref name="Rekart-2004">{{cite journal | vauthors = Rekart ML | title = Doxycycline:" New" treatment of choice for genital chlamydia infections. | journal = British Columbia Medical Journal | date = December 2004 | volume = 46 | issue = 10 | pages = 503 |url= http://www.bcmj.org/bc-centre-disease-control/doxycycline-new-treatment-choice-genital-chlamydia-infections |url-status=live |archive-url=https://web.archive.org/web/20170202025155/http://www.bcmj.org/bc-centre-disease-control/doxycycline-new-treatment-choice-genital-chlamydia-infections |archive-date=2 February 2017 }}</ref>

===Antibacterial===
==== General indications ====
Doxycycline is a broad-spectrum antibiotic that is employed in the treatment of numerous bacterial infections. It is effective against bacteria such as ''[[Moraxella catarrhalis]]'', ''[[Brucella melitensis]]'', ''[[Chlamydia pneumoniae]]'', and ''[[Mycoplasma pneumoniae]]''. Additionally, doxycycline is used in the prevention and treatment of serious conditions like anthrax, leptospirosis, bubonic plague, and Lyme disease. However, some bacteria, including ''[[Haemophilus]]'' spp., ''[[Mycoplasma hominis]]'', and ''[[Pseudomonas aeruginosa]]'', have shown resistance to doxycycline.<ref name="Doxycycline spectrum of bacterial susceptibility and Resistance">{{cite web|title=Doxycycline spectrum of bacterial susceptibility and Resistance|url=http://www.toku-e.com/Upload/Products/PDS/20120618002946.pdf|access-date=4 May 2012|url-status=dead|archive-url=https://web.archive.org/web/20140201153943/http://www.toku-e.com/Upload/Products/PDS/20120618002946.pdf|archive-date=1 February 2014}}</ref><ref name="Stoddard-2015">{{cite book | vauthors = Stoddard RA, Galloway RL, Guerra MA | chapter = Leptospirosis | chapter-url= https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/leptospirosis | title = Yellow Book |publisher=Centers for Disease Control and Prevention|access-date=16 April 2017|location=Atlanta, GA|date=10 July 2015|url-status=live|archive-url=https://web.archive.org/web/20170409045310/https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/leptospirosis|archive-date=9 April 2017}}</ref> It is also effective against ''[[Yersinia pestis]]'' (the infectious agent of [[bubonic plague]]), and is prescribed for the treatment of [[Lyme disease]],<ref name="pmid1637021">{{cite journal | vauthors = Nadelman RB, Luger SW, Frank E, Wisniewski M, Collins JJ, Wormser GP | title = Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease | journal = Annals of Internal Medicine | volume = 117 | issue = 4 | pages = 273–80 | date = August 1992 | pmid = 1637021 | doi = 10.7326/0003-4819-117-4-273 | s2cid = 23358315 }}</ref><ref name="pmid7793869">{{cite journal | vauthors = Luger SW, Paparone P, Wormser GP, Nadelman RB, Grunwaldt E, Gomez G, Wisniewski M, Collins JJ | title = Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans | journal = Antimicrobial Agents and Chemotherapy | volume = 39 | issue = 3 | pages = 661–7 | date = March 1995 | pmid = 7793869 | pmc = 162601 | doi = 10.1128/AAC.39.3.661 }}</ref><ref name="pmid11450675">{{cite journal | vauthors = Nadelman RB, Nowakowski J, Fish D, Falco RC, Freeman K, McKenna D, Welch P, Marcus R, Agüero-Rosenfeld ME, Dennis DT, Wormser GP | title = Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite | journal = The New England Journal of Medicine | volume = 345 | issue = 2 | pages = 79–84 | date = July 2001 | pmid = 11450675 | doi = 10.1056/NEJM200107123450201 | df = dmy-all | doi-access = free }}</ref><ref name="pmid8035916">{{cite journal | vauthors = Karlsson M, Hammers-Berggren S, Lindquist L, Stiernstedt G, Svenungsson B | title = Comparison of intravenous penicillin G and oral doxycycline for treatment of Lyme neuroborreliosis | journal = Neurology | volume = 44 | issue = 7 | pages = 1203–7 | date = July 1994 | pmid = 8035916 | doi = 10.1212/WNL.44.7.1203 | s2cid = 38661885 }}</ref> [[ehrlichiosis]],<ref name="pmid8900357">{{cite journal | vauthors = Weinstein RS | title = Human ehrlichiosis | journal = American Family Physician | volume = 54 | issue = 6 | pages = 1971–6 | date = November 1996 | pmid = 8900357 }}</ref><ref name="pmid11234985">{{cite journal | vauthors = Karlsson U, Bjöersdorff A, Massung RF, Christensson B | title = Human granulocytic ehrlichiosis--a clinical case in Scandinavia | journal = Scandinavian Journal of Infectious Diseases | volume = 33 | issue = 1 | pages = 73–4 | year = 2001 | pmid = 11234985 | doi = 10.1080/003655401750064130 | s2cid = 218880245 }}</ref> and [[Rocky Mountain spotted fever]].<ref name="FDA capsules label"/>

Specifically, doxycycline is indicated for treatment of the following diseases:<ref name="FDA capsules label">{{cite web | work = U.S. Food and Drug Administration | date = 14 December 2012 | url = http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/065055s012lbl.pdf | title = Doxycycline, ANDA no. 065055 Label. | archive-url = https://web.archive.org/web/20140419011523/http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/065055s012lbl.pdf | archive-date=19 April 2014 }}</ref><ref name="FDA oralsusp label">{{cite web | work = U.S. Food and Drug Administration | date = 16 July 2008 | url = http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/065454s000lbl.pdf | title = Doxycycline, ANDA no. 065454 Label | archive-url = https://web.archive.org/web/20131019104106/http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/065454s000lbl.pdf | archive-date=19 October 2013 }}</ref>
* [[Rocky Mountain spotted fever]], [[typhus]] fever and the typhus group, [[scrub typhus]],<ref name="pmid38110855">{{cite journal |vauthors=Gupta N, Boodman C, Jouego CG, Van Den Broucke S |title=Doxycycline vs azithromycin in patients with scrub typhus: a systematic review of literature and meta-analysis |journal=BMC Infect Dis |volume=23 |issue=1 |pages=884 |date=December 2023 |pmid=38110855 |pmc=10726538 |doi=10.1186/s12879-023-08893-7 |doi-access=free |url=}}</ref> [[Q fever]],<ref name="pmid23535757">{{cite journal | vauthors = Anderson A, Bijlmer H, Fournier PE, Graves S, Hartzell J, Kersh GJ, Limonard G, Marrie TJ, Massung RF, McQuiston JH, Nicholson WL, Paddock CD, Sexton DJ | title = Diagnosis and management of Q fever--United States, 2013: recommendations from CDC and the Q Fever Working Group | journal = MMWR. Recommendations and Reports | volume = 62 | issue = RR-03 | pages = 1–30 | date = March 2013 | pmid = 23535757 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm | url-status = live | df = dmy-all | archive-url = https://web.archive.org/web/20140419233615/http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm | archive-date = 19 April 2014 }}</ref> [[rickettsialpox]], and tick fevers caused by ''[[Rickettsia]]'',<ref name="pmid27172113">{{cite journal | url=https://www.cdc.gov/mmwr/volumes/65/rr/rr6502a1.htm | doi=10.15585/mmwr.rr6502a1 | title=Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Group Rickettsioses, Ehrlichioses, and Anaplasmosis — United States | date=2016 | journal=MMWR. Recommendations and Reports | volume=65 | issue=2 | pages=1–44 | pmid=27172113 | vauthors=Biggs HM, Behravesh CB, Bradley KK, Dahlgren FS, Drexler NA, Dumler JS, Folk SM, Kato CY, Lash RR, Levin ML, Massung RF, Nadelman RB, Nicholson WL, Paddock CD, Pritt BS, Traeger MS | doi-access=free | access-date=5 February 2024 | archive-date=28 January 2023 | archive-url=https://web.archive.org/web/20230128234432/https://www.cdc.gov/mmwr/volumes/65/rr/rr6502a1.htm | url-status=live }}</ref><ref name="Schutze-2010">{{cite news|title=Use doxycycline as first-line treatment for rickettsial diseases|url=https://publications.aap.org/aapnews/article-abstract/31/7/14/8731/Use-doxycycline-as-first-line-treatment-for?redirectedFrom=fulltext|date=1 July 2010| vauthors = Schutze GE, Regan J, Bradley J |series=AAP News|issn=1556-3332|publisher=American Academy of Pediatrics|access-date=5 February 2024|archive-date=5 February 2024|archive-url=https://web.archive.org/web/20240205201657/https://publications.aap.org/aapnews/article-abstract/31/7/14/8731/Use-doxycycline-as-first-line-treatment-for?redirectedFrom=fulltext|url-status=live}}</ref><ref name="Spotted fever group rickettsial disease DermNet 2024">{{cite web | url=https://dermnetnz.org/topics/spotted-fever | title=Spotted fever group rickettsial disease &#124; DermNet | date=26 October 2023 | access-date=5 February 2024 | archive-date=5 February 2024 | archive-url=https://web.archive.org/web/20240205201658/https://dermnetnz.org/topics/spotted-fever | url-status=live }}</ref>
* respiratory tract infections caused by ''[[Mycoplasma pneumoniae]]'',<ref name="pmid22972867">{{cite journal | vauthors = Okada T, Morozumi M, Tajima T, Hasegawa M, Sakata H, Ohnari S, Chiba N, Iwata S, Ubukata K | title = Rapid effectiveness of minocycline or doxycycline against macrolide-resistant Mycoplasma pneumoniae infection in a 2011 outbreak among Japanese children | journal = Clinical Infectious Diseases | volume = 55 | issue = 12 | pages = 1642–9 | date = December 2012 | pmid = 22972867 | doi = 10.1093/cid/cis784 | doi-access =  }}</ref>
* [[Lymphogranuloma venereum]], [[trachoma]], [[inclusion conjunctivitis]], and uncomplicated urethral, endocervical, or rectal infections in adults caused by ''[[Chlamydia trachomatis]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[psittacosis]],<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[non-gonococcal urethritis]] caused by ''[[Ureaplasma urealyticum]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[relapsing fever]] due to ''[[Borrelia recurrentis]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[chancroid]] caused by ''[[Haemophilus ducreyi]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* plague due to ''[[Yersinia pestis]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[tularemia]],<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[cholera]],<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* ''[[campylobacter fetus]]'' infections,<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[brucellosis]] caused by ''[[Brucella]]'' species (in conjunction with [[streptomycin]]),<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[bartonellosis]],<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[granuloma inguinale]] (''[[Klebsiella]]'' species),<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[Lyme disease]] (''[[Borrelia]]'' species).<ref name="Lyme disease. Treatment-2018"/>

==== Gram-negative bacteria specific indications ====
When bacteriologic testing indicates appropriate susceptibility to the drug, doxycycline may be used to treat these infections caused by [[Gram-negative bacteria]]:<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* ''[[Escherichia coli]]'' infections,<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* ''[[Enterobacter aerogenes]]'' (formerly ''Aerobacter aerogenes'') infections,<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* ''[[Shigella]]'' species infections,<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* ''[[Acinetobacter]]'' species (formerly ''Mima'' species and ''Herellea'' species) infections,<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[respiratory tract infections]] caused by ''[[Haemophilus influenzae]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* respiratory tract and [[urinary tract infection]]s caused by ''[[Klebsiella]]'' species.<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>

==== Gram-positive bacteria specific indications ====
Some [[Gram-positive bacteria]] have developed resistance to doxycycline. Up to 44% of ''[[Streptococcus pyogenes]]'' and up to 74% of ''[[Streptococcus faecalis|S. faecalis]]'' specimens have developed resistance to the [[Tetracycline antibiotics|tetracycline group]] of antibiotics. Up to 57% of [[Cutibacterium acnes|''P. acnes'']] strains developed resistance to doxycycline.<ref name="pmid24721547">{{cite journal | vauthors = Dreno B, Thiboutot D, Gollnick H, Bettoli V, Kang S, Leyden JJ, Shalita A, Torres V | title = Antibiotic stewardship in dermatology: limiting antibiotic use in acne | journal = European Journal of Dermatology | volume = 24 | issue = 3 | pages = 330–4 | date = 2014 | pmid = 24721547 | doi = 10.1684/ejd.2014.2309 | s2cid = 28700961 }}</ref> When bacteriologic testing indicates appropriate susceptibility to the drug, doxycycline may be used to treat these infections caused by [[Gram-positive bacteria]]:<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* upper respiratory infections caused by ''[[Streptococcus pneumoniae]]'' (formerly ''Diplococcus pneumoniae''),<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* skin and soft tissue infections caused by ''[[Staphylococcus aureus]]'', including [[methicillin-resistant Staphylococcus aureus|methicillin-resistant ''Staphylococcus aureus'']] infections,<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[anthrax]] caused by ''[[Bacillus anthracis]]'' infection.<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>

==== Specific applications of doxycycline when penicillin is contraindicated ====
When penicillin is contraindicated, doxycycline can be used to treat:<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[syphilis]] caused by ''[[Treponema pallidum]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[yaws]] caused by ''[[Treponema pertenue]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[listeriosis]] due to ''[[Listeria monocytogenes]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[Vincent's infection]] caused by ''[[Fusobacterium]] fusiforme'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* [[actinomycosis]] caused by ''[[Actinomyces israelii]]'',<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>
* infections caused by ''[[Clostridium]]'' species.<ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>

==== Use as adjunctive therapy ====
Doxycycline may also be used as adjunctive therapy for severe [[acne]].<ref name="pmid22895927">{{cite journal | vauthors = Garner SE, Eady A, Bennett C, Newton JN, Thomas K, Popescu CM | title = Minocycline for acne vulgaris: efficacy and safety | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 8 | pages = CD002086 | date = August 2012 | pmid = 22895927 | pmc = 7017847 | doi = 10.1002/14651858.CD002086.pub2 | collaboration = Cochrane Skin Group }}</ref><ref name="FDA capsules label"/><ref name="FDA oralsusp label"/>

Subantimicrobial-dose doxycycline (SDD) is widely used as an adjunctive treatment to scaling and root planing for [[periodontitis]]. Significant differences were observed for all investigated clinical parameters of periodontitis in favor of the scaling and root planing + SDD group where SDD dosage regimens is 20&nbsp;mg twice daily for three months in a [[meta-analysis]] published in 2011.<ref name="pmid21417590">{{cite journal | vauthors = Sgolastra F, Petrucci A, Gatto R, Giannoni M, Monaco A | title = Long-term efficacy of subantimicrobial-dose doxycycline as an adjunctive treatment to scaling and root planing: a systematic review and meta-analysis | journal = Journal of Periodontology | volume = 82 | issue = 11 | pages = 1570–1581 | date = November 2011 | pmid = 21417590 | doi = 10.1902/jop.2011.110026 }}</ref> SDD is also used to treat skin conditions such as acne and rosacea,<ref name="safety-2009"/><ref name="pmid25919144">{{cite journal | vauthors = van Zuuren EJ, Fedorowicz Z, Carter B, van der Linden MM, Charland L | title = Interventions for rosacea | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 4 | pages = CD003262 | date = April 2015 | pmid = 25919144 | pmc = 6481562 | doi = 10.1002/14651858.CD003262.pub5 | collaboration = Cochrane Skin Group }}</ref><ref name="pmid25597924">{{cite journal | vauthors = Cao H, Yang G, Wang Y, Liu JP, Smith CA, Luo H, Liu Y | title = Complementary therapies for acne vulgaris | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD009436 | date = January 2015 | pmid = 25597924 | pmc = 4486007 | doi = 10.1002/14651858.CD009436.pub2 | collaboration = Cochrane Skin Group }}</ref> including ocular rosacea.<ref name="pmid38361192"/> In ocular rosacea, treatment period is 2 to 3 months. After discontinuation of doxycycline, recurrences may occur within three months; therefore, many studies recommend either slow tapering or treatment with a lower dose over a longer period of time.<ref name="pmid38361192">{{cite journal |vauthors=Avraham S, Khaslavsky S, Kashetsky N, Starkey SY, Zaslavsky K, Lam JM, Mukovozov I |title=Therapie der okulären Rosazea: Eine systematische Literatur-Übersicht: Treatment of ocular rosacea: a systematic review |journal=J Dtsch Dermatol Ges |volume=22 |issue=2 |pages=167–176 |date=February 2024 |pmid=38361192 |doi=10.1111/ddg.15290_g |url=}}</ref>

Doxycycline is used as an adjunctive therapy for acute [[intestinal amebiasis]].<ref name="drugs-com">{{cite web | url=https://www.drugs.com/dosage/doxycycline.html | title=Doxycycline Dosage Guide + Max Dose, Adjustments | access-date=5 February 2024 | archive-date=5 February 2024 | archive-url=https://web.archive.org/web/20240205202304/https://www.drugs.com/dosage/doxycycline.html | url-status=live }}</ref>

Doxycycline is also used as an adjunctive therapy for [[chancroid]].<ref name="drugs-com"/>

==== As prophylaxis against sexually transmitted infections ====
Doxycycline is used for post-exposure prophylaxis (PEP) to reduce the incidence of sexually transmitted bacterial infections (STIs), but it has been associated with tetracycline resistance in associated species, in particular, in [[Neisseria gonorrhoeae]].<ref name="pmid38575877">{{cite journal |vauthors=Vanbaelen T, Manoharan-Basil SS, Kenyon C |title=45 years of tetracycline post exposure prophylaxis for STIs and the risk of tetracycline resistance: a systematic review and meta-analysis |journal=BMC Infect Dis |volume=24 |issue=1 |pages=376 |date=April 2024 |pmid=38575877 |pmc=10996150 |doi=10.1186/s12879-024-09275-3|doi-access=free }}</ref><ref name="Samuel-2023">{{cite web |vauthors=Samuel K |title=Using antibiotics to prevent STIs |url=https://www.aidsmap.com/about-hiv/using-antibiotics-prevent-stis |website=Aidsmap |date=26 May 2023 |access-date=10 March 2024 |archive-date=10 March 2024 |archive-url=https://web.archive.org/web/20240310162916/https://www.aidsmap.com/about-hiv/using-antibiotics-prevent-stis |url-status=live }}</ref><ref name="pmid38118022">{{cite journal |vauthors=Stewart J |title=Doxycycline Prophylaxis to Prevent Sexually Transmitted Infections in Women |journal=New England Journal of Medicine |date=21 December 2023 |volume=389 |issue=25 |pages=2331–2340 |doi=10.1056/NEJMoa2304007 |pmid=38118022 |pmc=10805625 }}</ref> For this reason, the Australian consensus statement mentions that doxycycline for PEP particularly in gay, bisexual, and other men who have sex with men (GBMSM) should be considered only for the prevention of syphilis in GBMSM, and that the risk of increasing antimicrobial resistance outweighed any potential benefit from reductions in other bacterial STIs in GBMSM.<ref name="pmid38479437">{{cite journal |vauthors=Cornelisse VJ, Riley B, Medland NA |title=Australian consensus statement on doxycycline post-exposure prophylaxis (doxy-PEP) for the prevention of syphilis, chlamydia and gonorrhoea among gay, bisexual and other men who have sex with men |journal=Med J Aust |volume=220 |issue=7 |pages=381–386 |date=April 2024 |pmid=38479437 |doi=10.5694/mja2.52258|doi-access=free }}</ref>

Appropriate use of doxycycline for PEP is supported by guidelines from the [[Centers for Disease Control and Prevention|US Centers for Disease Control and Prevention]] (CDC)<ref name="CDC-2023-Gudelines-Post-Exposure">{{cite web |title=Guidelines for the Use of Doxycycline Post-Exposure Prophylaxis for Bacterial STI Prevention |url=https://www.cdc.gov/std/treatment/guidelines-for-doxycycline.htm |website=CDC |date=29 September 2023 |access-date=10 March 2024 |archive-date=10 March 2024 |archive-url=https://web.archive.org/web/20240310162915/https://www.cdc.gov/std/treatment/guidelines-for-doxycycline.htm |url-status=live }}</ref> and the Australasian Society for HIV Medicine.<ref name="Australasian Society for HIV Medicine 2023">{{cite web |title=2023 Consensus Statement on doxycycline prophylaxis (Doxy-PEP) for the prevention of syphilis, chlamydia and gonorrhoea among gay, bisexual, and other men who have sex with men in Australia |url=https://ashm.org.au/about/news/doxy-pep-statement/ |website=Australasian Society for HIV Medicine |access-date=10 March 2024 |archive-date=10 March 2024 |archive-url=https://web.archive.org/web/20240310162917/https://ashm.org.au/about/news/doxy-pep-statement/ |url-status=live }}</ref><ref name="Highleyman-2024">{{cite web |vauthors=Highleyman L |title=Sexually transmitted infections in San Francisco have fallen since doxyPEP roll-out |url=https://www.aidsmap.com/news/mar-2024/sexually-transmitted-infections-san-francisco-have-fallen-doxypep-roll-out |website=Aidsmap |date=5 March 2024 |access-date=10 March 2024 |archive-date=10 March 2024 |archive-url=https://web.archive.org/web/20240310162916/https://www.aidsmap.com/news/mar-2024/sexually-transmitted-infections-san-francisco-have-fallen-doxypep-roll-out |url-status=live }}</ref>

==== Use in combination ====
The first-line treatment for [[brucellosis]] is a combination of doxycycline and [[streptomycin]]. The second-line is a combination of doxycycline and [[rifampicin]] (rifampin).<ref name="pmid22296864">{{cite journal | vauthors = Hashemi SH, Gachkar L, Keramat F, Mamani M, Hajilooi M, Janbakhsh A, Majzoobi MM, Mahjub H | title = Comparison of doxycycline-streptomycin, doxycycline-rifampin, and ofloxacin-rifampin in the treatment of brucellosis: a randomized clinical trial | journal = International Journal of Infectious Diseases | volume = 16 | issue = 4 | pages = e247–e251 | date = April 2012 | pmid = 22296864 | doi = 10.1016/j.ijid.2011.12.003 | doi-access = free }}</ref>

===Antimalarial===
Doxycycline is active against the erythrocytic stages of ''[[Plasmodium falciparum]]'' but not against the gametocytes of ''P. falciparum''.<ref name="DailyMed-2020">{{cite web | title=Doryx- doxycycline hyclate tablet, delayed release | website=DailyMed | date=23 October 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99cf2de6-e0a3-42f2-9929-d33e107af948 | access-date=5 March 2022 | archive-date=3 January 2022 | archive-url=https://web.archive.org/web/20220103004820/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=99cf2de6-e0a3-42f2-9929-d33e107af948 | url-status=live }}</ref> It is used to prevent [[malaria]].<ref name="CDC">{{cite web |title=Malaria - Chapter 3 - 2018 Yellow Book {{!}} Travelers' Health {{!}} CDC |url=https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/malaria |website=CDC |access-date=4 December 2018 |archive-date=3 December 2018 |archive-url=https://web.archive.org/web/20181203193423/https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/malaria |url-status=live }}</ref> It is not recommended alone for initial treatment of malaria, even when the parasite is doxycycline-sensitive, because the antimalarial effect of doxycycline is delayed.<ref name="pmid16940111">{{cite journal | vauthors = Dahl EL, Shock JL, Shenai BR, Gut J, DeRisi JL, Rosenthal PJ | title = Tetracyclines specifically target the apicoplast of the malaria parasite Plasmodium falciparum | journal = Antimicrobial Agents and Chemotherapy | volume = 50 | issue = 9 | pages = 3124–31 | date = September 2006 | pmid = 16940111 | pmc = 1563505 | doi = 10.1128/AAC.00394-06 }}</ref>

Doxycycline blocks protein production in [[apicoplast]] (an [[organelle]]) of ''P. falciparum''—such blocking leads to two main effects: it disrupts the parasite's ability to produce fatty acids, which are essential for its growth, and it impairs the production of heme, a cofactor. These effects occur late in the parasite's life cycle when it is in the blood stage, causing the symptoms of malaria.<ref name="Holmes-2009">{{cite journal|doi=10.4137/CMT.S2035 |title=Safety and Efficacy Review of Doxycycline |date=2009 |journal=Clinical Medicine. Therapeutics |volume=1 |pages=CMT.S2035 | vauthors = Holmes NE, Charles PG }}</ref> By blocking important processes in the parasite, doxycycline both inhibits the growth and prevents the multiplication of ''P. falciparum''. It does not directly kill the living organisms of ''P. falciparum'' but creates conditions that prevent their growth and replication.<ref name="pmid26555664">{{cite journal |vauthors=Gaillard T, Madamet M, Pradines B |title=Tetracyclines in malaria |journal=Malar J |volume=14 |pages=445 |date=November 2015 |pmid=26555664 |pmc=4641395 |doi=10.1186/s12936-015-0980-0 |doi-access=free |url=}}</ref>

The [[World Health Organization]] (WHO) guidelines state that the combination of doxycycline with either artesunate or quinine may be used for the treatment of uncomplicated malaria due to ''[[Plasmodium falciparum|P. falciparum]]'' or following intravenous treatment of severe malaria.<ref name="World Health Organization-2015">{{cite book | title = Guidelines for the treatment of malaria | publisher = World Health Organization | location = Geneva | year = 2015 | isbn = 978-92-4-154912-7|page = 246 }}</ref>

===Antihelminthic===
Doxycycline kills the [[symbiosis|symbiotic]] ''[[Wolbachia]]'' bacteria in the reproductive tracts of [[parasitic]] [[filarial]] [[nematodes]], making the nematodes sterile, and thus reducing transmission of diseases such as [[onchocerciasis]] and [[elephantiasis tropica|elephantiasis]].<ref name="pmid12684759">{{cite journal | vauthors = Hoerauf A, Mand S, Fischer K, Kruppa T, Marfo-Debrekyei Y, Debrah AY, Pfarr KM, Adjei O, Büttner DW | title = Doxycycline as a novel strategy against bancroftian filariasis-depletion of Wolbachia endosymbionts from Wuchereria bancrofti and stop of microfilaria production | journal = Medical Microbiology and Immunology | volume = 192 | issue = 4 | pages = 211–6 | date = November 2003 | pmid = 12684759 | doi = 10.1007/s00430-002-0174-6 | s2cid = 23349595 }}</ref> Field trials in 2005 showed an eight-week course of doxycycline almost eliminates the release of [[microfilariae]].<ref name="pmid15964448">{{cite journal | vauthors = Taylor MJ, Makunde WH, McGarry HF, Turner JD, Mand S, Hoerauf A | title = Macrofilaricidal activity after doxycycline treatment of Wuchereria bancrofti: a double-blind, randomised placebo-controlled trial | journal = Lancet | volume = 365 | issue = 9477 | pages = 2116–21 | year = 2005 | pmid = 15964448 | doi = 10.1016/S0140-6736(05)66591-9 | s2cid = 21382828 }}</ref>

===Spectrum of susceptibility===
Doxycycline has been used successfully to treat sexually transmitted, respiratory, and ophthalmic infections. Representative pathogenic genera include ''[[Chlamydia]], [[Streptococcus]], [[Ureaplasma]], [[Mycoplasma]]'', and others. The following represents [[minimum inhibitory concentration]] susceptibility data for a few medically significant microorganisms.<ref name="toku-e.com">{{cite web|title=Doxycycline hyclate Susceptibility and Minimum Inhibitory Concentration (MIC) Data|url=http://www.toku-e.com/Assets/MIC/Doxycycline%20hyclate.pdf|website=toku-e.com|access-date=16 April 2017|archive-date=24 February 2015|archive-url=https://web.archive.org/web/20150224063348/http://www.toku-e.com/Assets/MIC/Doxycycline%20hyclate.pdf|url-status=live}}</ref>
* ''[[Chlamydia psittaci]]'': 0.03&nbsp;''μ''g/mL<ref name="toku-e.com"/>
* ''[[Mycoplasma pneumoniae]]'': 0.016–2&nbsp;''μ''g/mL<ref name="toku-e.com"/>
* ''[[Streptococcus pneumoniae]]'': 0.06–32&nbsp;''μ''g/mL<ref name="toku-e.com"/>

=== Sclerotherapy ===
Doxycycline is also used for [[sclerotherapy]] in slow-flow vascular malformations, namely [[Venous malformation|venous]] and [[lymphatic malformation]]s, as well as post-operative [[lymphocele]]s.<ref name="Kaufman-2013">{{cite book| vauthors = Kaufman JA, Lee MJ |title=Vascular and interventional radiology|date=22 June 2013|isbn=978-0-323-07672-2|edition=2nd|location=Philadelphia, PA | publisher = Saunders |oclc=853455295}}</ref>