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tetracyclines and photosensitivity : what about doxycycline?
harold jitschak bueno de mesquita,
family-physician
93384Send response to journal:
Re: tetracyclines and photosensitivity : what about doxycycline?
In the 35 years of practice I have been using whenever necessary, Doxycycline as a main antibiotic for fitting conditions. I can’t recall having seen a single photosensitivity reaction to it, even while working in the tropics [Surinam], even in the “white population” [memory-problems??]
Another thing: I have seen doxycycline being effective when other antibiotics failed, even if the culture showed a sigh sensitivity to these antibiotics and not to doxycycline. Recently I treated a hospitalized patient with a lung abscess with doxycycline after he did not reacted to the “best chosen antibiotics” in the hospital and there was a remarkable quick recovery after the doxycycline.
In this connection I read with interest recently the following article about doxycycline: Joshi N, Miller DQ: Doxycycline revisited. Arch Intern Med 157:1421, 1997Competing interests: None declared

Joshi N, Miller DQ: Doxycycline revisited. Arch Intern Med 157:1421, 1997

COMMENT: When there is little economic incentive to study and market drugs such as doxycycline, they tend to be forgotten. The consequence is that newer, glitzier, and more costly antimicrobials are prescribed even when conventional, therapeutically equivalent agents would suffice. Let’s hear it for an oldie but goodie.

Continued Usefulness of Doxycycline
(return to 
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Although few truly new classes of antimicrobials have been introduced in recent years, physicians continue to be inundated with strongly hyped modifications of established drugs. These include new cephalosporins, combinations of beta-lactams and beta-lactam inhibitors, macrolides, and a plethora of quinolones. Some represent real advances, while others are merely “me too” agents designed to garner a portion of a highly lucrative market. Whatever their virtues, almost all can be expected to be expensive. Given the imperatives of cost containment in modern medicine, it is well to remember that certain tried-and-true antimicrobials remain both efficacious and cost-effective.

In this spirit, internists from Pennsylvania State University at Hershey have published a timely review entitled “Doxycycline Revisited.” When the drug was introduced three decades ago, it represented a marked advance over the available tetracyclines. Since it is almost completely absorbed from the upper gastrointestinal tract, serum levels following oral administration are essentially equivalent to levels achieved by intravenous infusion. So little is left in the lower gastrointestinal tract that fecal flora is not as perturbed as it is with other tetracyclines. Doxycycline’s enhanced lipophilic activity is perhaps responsible for its excellent tissue penetration and longer half-life permitting once- or twice-daily administration. Another major plus is that the drug does not accumulate in renal failure, nor does it exert a catabolic effect–major problems with its predecessors.

In 1997, doxycycline remains a drug of choice for Lyme disease, chlamydial infections causing nongonococcal urethritis, pelvic inflammatory disease, lymphogranuloma venereum, brucellosis, and rickettsial infections such as Rocky Mountain spotted fever. It is also a reasonable choice in selected cases of urinary-tract infection and community-acquired pneumonia. In addition, the drug is effective in preventing falciparum malaria in areas where multidrug resistance is high. Adverse reactions to doxycycline are relatively rare but include pill-induced esophageal ulceration, photosensitivity, enhancement of warfarin anticoagulation, and deposition in the teeth and bones of fetuses and young children.

Joshi N, Miller DQ: Doxycycline revisited. Arch Intern Med 157:1421, 1997

COMMENT: When there is little economic incentive to study and market drugs such as doxycycline, they tend to be forgotten. The consequence is that newer, glitzier, and more costly antimicrobials are prescribed even when conventional, therapeutically equivalent agents would suffice. Let’s hear it for an oldie but goodie.