What is the role of doxycycline in the treatment of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E) cystitis? How does it compare to other antibiotic options? What factors should be considered when prescribing doxycycline for this condition?

Doxycycline’s Role in ESBL-E Cystitis

The treatment of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E) cystitis can be a clinical challenge, as these infections are often resistant to many first-line antibiotic options. In a recent guidance document, Tamma et al. recommended against the use of doxycycline for the treatment of ESBL-E infections [1]. However, the supporting reference for this statement has been called into question by Jodlowski et al. in a letter to the editor published in Clinical Infectious Diseases.

Exploring the Evidence on Doxycycline for ESBL-E Cystitis

Jodlowski and colleagues argue that the evidence on the use of doxycycline for ESBL-E cystitis may not be as clear-cut as the guidance suggests. They note that a previous study found doxycycline to be an effective treatment option for ESBL-producing Enterobacteriaceae infections, including cystitis [2]. Additionally, in vitro data has shown that doxycycline may retain activity against some ESBL-producing E. coli strains [3].

Factors to Consider When Prescribing Doxycycline

While the debate on the optimal antibiotic treatment for ESBL-E cystitis continues, there are several important factors to consider when prescribing doxycycline for this condition:

Antibiotic Resistance Patterns

The efficacy of doxycycline may vary depending on the local resistance patterns of the ESBL-E isolates. Clinicians should carefully review antibiotic susceptibility data before prescribing doxycycline.

Patient Characteristics

Factors such as the patient’s age, kidney function, and comorbidities may influence the suitability of doxycycline as a treatment option. Careful patient selection is crucial when considering doxycycline for ESBL-E cystitis.

Clinical Outcomes

While in vitro data may suggest potential activity of doxycycline against ESBL-E, it is important to evaluate the clinical outcomes of using doxycycline in real-world settings. Further research is needed to better understand the efficacy of doxycycline in the treatment of ESBL-E cystitis.

Conclusion

The role of doxycycline in the treatment of ESBL-E cystitis remains a topic of debate. While the recent guidance recommends against its use, the evidence may not be as clear-cut as it suggests. Clinicians should carefully consider the local resistance patterns, patient characteristics, and clinical outcomes when evaluating doxycycline as a treatment option for ESBL-E cystitis.

Key Takeaways

• The use of doxycycline for ESBL-E cystitis is a subject of ongoing discussion, with conflicting evidence on its efficacy.
• Factors such as antibiotic resistance patterns, patient characteristics, and clinical outcomes should be carefully considered when prescribing doxycycline for this condition.
• Further research is needed to better understand the role of doxycycline in the management of ESBL-E cystitis.

Future Research Directions

To gain a clearer understanding of the utility of doxycycline for ESBL-E cystitis, several areas of future research could be explored:

1. Well-designed clinical studies to evaluate the real-world efficacy of doxycycline in treating ESBL-E cystitis, including comprehensive assessments of clinical outcomes and safety profiles.
2. Investigations into the specific mechanisms of resistance and susceptibility patterns of ESBL-E isolates to doxycycline, which could help guide targeted use of the antibiotic.
3. Exploration of combination therapy approaches, where doxycycline is used in conjunction with other antibiotics, to potentially enhance the effectiveness against ESBL-E infections.

By addressing these research gaps, clinicians can make more informed decisions on the appropriate use of doxycycline for the management of ESBL-E cystitis, ultimately improving patient outcomes.

Doxycycline for ESBL-E Cystitis | Clinical Infectious Diseases

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Clinical Infectious Diseases, Volume 73, Issue 1, 1 July 2021, Pages e274–e275, https://doi. org/10.1093/cid/ciaa1898

Published:

29 December 2020

Article history

Published:

29 December 2020

Corrected and typeset:

16 February 2021

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To the Editor—With great anticipation we read the recently published ahead-of-print guidance on the treatment of antimicrobial resistant gram-negative infections by Tamma et al [1]. It is a very timely, well written, and useful document. However, we noticed the supporting reference for the statement: “Doxycycline is not recommended for the treatment of extended spectrum beta-lactamase—Enterobacterales (ESBL-E) cystitis due to limited urinary excretion,” on page 6. We do not support this statement as approximately 35%–60% of an oral dose of 100 mg of doxycycline dose is excreted unchanged into the urine [2]. The concentrations of doxycycline following a 100 mg oral dose in the urine can range from 60–300 μg/mL in patients with normal renal function, which is significantly greater than the MIC for the extended spectrum beta-lactamase (ESBL)-E that cause acute cystitis [3, 4].

Clinical data indicate that doxycycline has efficacy against susceptible Gram-positive uropathogens, such as Enterococcus faecalis and E. faecium including vancomycin-resistant E. fecium (VRE) and Gram-negative organisms, including E. coli and K. pneumoniae, that cause urinary cystitis [4–7] Additionally, it was also successful in eradication of VRE in the urine [8].

However, doxycycline is typically not used to treat urinary tract infections. This could be due to the fact that neither doxycycline nor tetracycline are always tested or reported against Gram-negative bacteria. There could also be a lack of knowledge regarding the concentrations reached in the urine that greatly exceed the MIC values for certain uropathogens. Its antimicrobial efficacy is increased in acidic environments, including urine [4]. Given the increased incidence in multidrug-resistant Gram-negative bacterial infections and the favorable pharmacokinetic and safety profile of doxycycline, perhaps its use for treating certain types of acute cystitis should be reconsidered. Following oral administration, 95% of a 100 mg dose of doxycycline is absorbed; doxycycline can be used in patients with renal insufficiency as there is a compensatory increase in nonrenal elimination [9]. Doxycycline is generally well tolerated and the most commonly reported adverse effects include nausea, vomiting, diarrhea, epigastric pain, photosensitivity reactions but the rate of treatment discontinuation is low. It has a low propensity for producing Clostridioides difficile infections [10], meanwhile a normal treatment course is relatively inexpensive. Doxycycline should not be given to pregnant females and children under the age of 8 due to the risk of permanent discoloration of developing teeth [5, 9]. Finally, doxycycline does not inhibit or induce any of the Phase I or II drug metabolizing enzymes, thus decreasing the likelihood of drug–drug interactions,

In conclusion, based on the published pharmacokinetic data and MIC values for uropathogenic ESBL-E, doxycycline reaches levels in the urine that should make it a potential option for the treatment of acute cystitis caused by ESBL-E.

Nonstandard Abbreviations

Nonstandard Abbreviations

 

• ESBL-E

  extended spectrum beta-lactamase Enterobacterales

 

• VRE

  vancomycin-resistant E. fecium

Note

Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

References

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Aitken

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, et al. 

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White

CR

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TZ

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Atkins

DT

,

Holland

NG

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Successful doxycycline therapy in a patient with Escherichia coli and multidrug-resistant Klebsiella pneumoniae urinary tract infection

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Lockey

JE

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, et al. 

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© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

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Successful Doxycycline Therapy in a Patient With Escherichia coli and Multidrug-Resistant Klebsiella pneumoniae Urinary Tract Infection

Case Reports

. 2017 Aug;30(4):464-467.

doi: 10.1177/0897190016642362.

Epub 2016 Apr 12.

Cassandra R White 
^1
 
2
, Tomasz Z Jodlowski 
²
, Dylan T Atkins 
¹
, Nicole G Holland 
¹

Affiliations

Affiliations

• ¹ 1 Husson University School of Pharmacy, Bangor, ME, USA.
• ² 2 VA Maine Healthcare System, Augusta, ME, USA.

• PMID:

  27071978

• DOI:

  10. 1177/0897190016642362

Case Reports

Cassandra R White et al.

J Pharm Pract.

2017 Aug.

. 2017 Aug;30(4):464-467.

doi: 10.1177/0897190016642362.

Epub 2016 Apr 12.

Authors

Cassandra R White 
^1
 
2
, Tomasz Z Jodlowski 
²
, Dylan T Atkins 
¹
, Nicole G Holland 
¹

Affiliations

• ¹ 1 Husson University School of Pharmacy, Bangor, ME, USA.
• ² 2 VA Maine Healthcare System, Augusta, ME, USA.

• PMID:

  27071978

• DOI:

  10.1177/0897190016642362

Abstract

Objective:

To report on a patient with a symptomatic, polymicrobial Escherichia coli and multidrug-resistant (MDR), extended-spectrum β-lactamase (ESBL)-positive Klebsiella pneumoniae urinary tract infection (UTI) who was successfully treated with oral doxycycline hyclate.

Case summary:

A 70-year-old white male inpatient with a history of recurrent UTI, type 2 diabetes, hypertension, obesity, and diverticular disease was diagnosed with UTI and empirically treated with oral ciprofloxacin. Symptoms persisted 2 days later, and the patient was transitioned to amoxicillin/clavulanate by a different provider. The next day, upon receipt of the urine culture and susceptibility panel revealing E coli and MDR, ESBL-positive K pneumoniae infection, treatment was switched to doxycycline hyclate, which resulted in clinical improvement.

Discussion:

Complicated UTI involving multiple pathogens requires careful clinical judgment to select the appropriate antimicrobial agent, improve clinical outcomes, and prevent resistance. Treatment with doxycycline was based on the susceptibility panel and local resistance patterns. Advantages of doxycycline for UTI include its oral formulation, wide spectrum of activity, ability to achieve high concentration in the urine, and low toxicity.

Conclusion:

Doxycycline hyclate may be an effective treatment option for patients with susceptible MDR UTI.

Keywords:

bacterial resistance; doxycycline; infectious disease; urology.

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main uses and treatment efficacy

Doxycycline is a broad-spectrum antibiotic in dentistry. It is effective in the treatment of dental infection, purulent processes, periodontitis and other diseases of the oral cavity. Learn all about the use of doxycycline in dentistry in our article.

Doxycycline is one of the most commonly used broad spectrum antibiotics and is widely used in dentistry. Its features and effectiveness are proven by years of use and research.

The main use of doxycycline in dentistry is the treatment of oral diseases associated with the development of infections. These diseases include purulent processes, periodontitis, periodontitis, trauma and other pathologies. All of them are characterized by the presence of a bacterial infection, which Doxycycline helps to treat effectively.

Doxycycline is able to quickly and successfully penetrate tissues and cells, and has a high activity against a wide range of bacteria and microorganisms. It effectively fights inflammatory processes, has an antibacterial effect and improves the function of foci of infection.

Although effective, doxycycline, like any other antibiotic, is not safe if used incorrectly. Dosage, frequency of administration and duration of treatment should be determined by the doctor, based on the nature and severity of the disease.

In the article we will consider the use of doxycycline in dentistry in more detail, as well as sum up the research and experience of use.

Doxycycline is a tetracycline antibiotic widely used in dentistry to treat infections caused by bacteria.

The use of doxycycline in dentistry is an effective treatment for bacterial infections. However, like any antibiotic, it can cause side effects such as diarrhea, nausea, and headache. When prescribing doxycycline, the doctor should take into account the individual characteristics of each patient and, if necessary, adjust the dosage and duration of the drug.

In general, doxycycline is an important tool in the dentist’s sleeve to fight bacterial infections and should only be given when indicated.

Doxycycline is a tetracycline antibiotic widely used in dentistry due to its pronounced properties:

In dentistry, doxycycline is often used to treat infections caused by various types of bacteria, such as periodontitis, abscesses, abscesses, angular cheilitis and others.

Doxycycline may be used as tablets or solutions for oral or injectable use. However, before using doxycycline, it is necessary to consult a specialist and prescribe the appropriate dosage for each individual patient, depending on his state of health.

Q&A:

Which diseases of the mouth and teeth can be treated with doxycycline?

Doxycycline is used to treat diseases such as periodontitis, peri-implantitis, chronic gingivitis and periodontitis. It can also help treat abscesses, osteomyelitis, and other infections of the mouth and teeth.

How does doxycycline work in the treatment of oral diseases?

Doxycycline belongs to the tetracycline group and it destroys bacteria that cause diseases of the mouth and teeth. It can also reduce inflammation and pain.

Can doxycycline cause side effects in the treatment of oral diseases?

Yes, doxycycline may cause some side effects such as nausea, vomiting, diarrhea, and changes in taste. More serious side effects are minor and very rare.

Can doxycycline be used while pregnant or breastfeeding?

Doxycycline is not recommended for use during pregnancy as it may harm the fetus. It is also not recommended when breastfeeding, because it can pass into milk and cause unwanted effects in the baby.

When is doxycycline better than other antibiotics for treating oral problems?

Doxycycline may be more effective than other antibiotics in treating diseases of the mouth and teeth caused by anaerobic bacteria.

How long should doxycycline be taken to treat oral disease?

The duration of doxycycline administration is determined by the doctor, depending on the severity of the disease and the individual characteristics of the patient. Usually, in the treatment of diseases of the oral cavity, the period of taking doxycycline is 7-10 days.

What is the likelihood of a recurrence of the disease after treatment with doxycycline?

The likelihood of a recurrence of the disease after treatment with doxycycline depends on many factors, including one’s own health and oral hygiene. To reduce the risk of recurrence of the disease, you should follow preventive measures and visit the dentist regularly.

Dosage and method of administration

Doxycycline is presented in the form of tablets, capsules and powder for solution for intravenous and intramuscular administration.

In dentistry, doxycycline capsules are the most commonly used. For adults and children over 8 years of age, it is recommended to start treatment with a dose of 100 mg per day. In severe infectious diseases, the dose can be increased to 200 mg per day.

Doxycycline is taken after meals with plenty of water. It is best to take the drug at the same time to maintain a constant concentration of the drug in the blood.

The duration of doxycycline administration depends on the type of infection and its severity. Usually the course of treatment is from 5 to 14 days.

It is important to remember that doxycycline is not recommended for pregnant and lactating women and children under 8 years of age. Before starting treatment, be sure to consult your doctor and read the instructions for use.

Efficacy in the treatment of gum disease

Doxycycline, as a broad-spectrum antibiotic, can be effectively used in the treatment of gum disease. So, for example, in the case of periodontitis, doxycycline helps to reduce inflammation of the gums and slow down the process of tooth decay.

In addition, doxycycline can be used for gingivitis, a gum disease caused by a bacterial infection. In this case, it can be prescribed as an independent medicine or combined with other medicines.

Already a few days after starting doxycycline, the patient can feel a significant improvement in the condition of the gums: reduction of inflammation, bleeding and soreness. However, it should be remembered that the self-administration and use of doxycycline can lead to undesirable consequences, so be sure to follow the recommendations of the dentist and complete the full course of treatment.

In general, it can be concluded that the use of doxycycline in dentistry as a treatment for gum disease is an effective method that helps to quickly eliminate symptoms and stop the progression of the disease, provided that it is correctly and timely administered.

Indications for the use of the drug in periodontitis

Periodontitis is a disease accompanied by inflammation of periodontal tissues. It is usually caused by a bacterial infection that enters the gum gap and causes destruction of the dental tissue. Doxycycline is one of the most effective drugs for the treatment of periodontitis.

Indications for the use of doxycycline in periodontitis include:

• Gum disease;
• Deep carious patch;
• Periodontitis;
• Periostitis;
• Stomatitis.

Doxycycline has an anti-inflammatory, antibacterial effect that helps reduce the risk of complications and the rate of recurrence of the disease. In addition, the drug helps to narrow the gum gaps, which accelerates regeneration and facilitates the healing process of wounds.

Treatment of infectious diseases of the oral cavity

Infectious diseases of the oral cavity are a common reason for visiting the dentist. They can present with a variety of symptoms, such as bleeding gums, pain when chewing, and tooth sensitivity.

Doxycycline is an effective drug for the treatment of oral infections. It is able to fight bacterial infection, reduce inflammation and reduce pain.

Doxycycline can be used both in the form of tablets and in the form of a gel for external use on the gums. However, like any other medication, doxycycline has side effects such as nausea, vomiting, and diarrhea. If you experience any side effects, you should consult a doctor to adjust the treatment.

In addition to the use of medications, it is also important to maintain proper oral hygiene, brush your teeth regularly and use dental floss. A healthy oral cavity promotes rapid recovery and prevention of infections.

Use of doxycycline for gingivitis

Gingivitis is a common oral disease characterized by inflammation of the gums. It can be caused by a variety of factors, including poor oral hygiene, bacterial infection, and bad habits such as smoking.

Doxycycline is one of the effective drugs for the treatment of gingivitis. It belongs to the group of tetracycline antibiotics and acts on various bacteria that can cause gum disease.

Doxycycline can be used alone or in combination with other drugs to more effectively treat gingivitis. It can be prescribed both in the form of tablets and as a topical agent.

When using doxycycline, you must follow the recommendations of your dentist or doctor to avoid side effects and achieve a positive result. Usually the course of treatment lasts from 7 to 14 days.

Like all antibiotics, doxycycline can cause some side effects such as nausea, vomiting, diarrhea, headache, etc. If you experience any side effects, you should contact your doctor immediately.

In general, the use of doxycycline for gingivitis is an effective and safe way to combat gingivitis. However, you need to take care of your oral hygiene, correct bad habits, and boost your immune system to minimize the risk of a return of the disease in the future.

Treatment outcomes for oropharyngeal candidiasis infection

Oropharyngeal candidiasis is a common fungal infection that affects the mucous membranes of the mouth and throat. Prolonged exposure to antibiotic therapy, use of steroids, immunocompromised and systemic patients, and diabetic patients are considered to be the most susceptible to this disease.

The antibacterial drug doxycycline is widely used in dentistry to treat oropharyngeal candidiasis infection. This treatment, as a rule, leads to positive results and is most effective if the disease is detected at an early stage of development.

Studies show that doxycycline can reduce infectious activity in the local area, destroy fungal colonies and prevent the recurrence of the disease. In addition, this drug has antibacterial and anti-infective properties, due to which it is effective against various types of microorganisms, including candida.

Patients treated with doxycycline for oropharyngeal candidiasis infection report a significant improvement in their condition. Most of them noted a decrease in soreness, swelling and the risk of complications. However, before starting treatment, you should contact an experienced dentist who will correctly assess the clinical picture and select the necessary funds for the treatment of this disease.

Use of the drug in case of frequent relapses of infectious diseases

Doxycycline is a broad-spectrum drug used in dentistry in the treatment of infectious diseases such as periodontitis, osteomyelitis, periodontitis and others. In addition, doxycycline can be used to prevent infection after surgery and in immunocompromised patients.

Frequent recurrences of infectious diseases are a problem that dentists face every day. This may be due to the presence of bacteria in the dentoalveolar system, which are not removed by normal oral hygiene. In such cases, doxycycline can help eliminate the bacteria and prevent the disease from recurring.

To achieve the best results when using doxycycline, follow the recommendations of the dentist and follow the rules of oral hygiene. In addition, it is worth remembering the possible side effects of the drug, such as digestive disorders, allergic reactions, dysbacteriosis and others.

Insufficient information about the correct use of the drug can lead to the development of complications and deterioration of the dentoalveolar system. Therefore, before using doxycycline, you should consult with a specialist and follow his recommendations.

Effectiveness of doxycycline in the treatment of periodontal disease

Periodontitis is a periodontal disease characterized by inflammation of the gums and destruction of the substance that supports the teeth in the mouth. Treatment of this disease requires complex therapy, which includes oral hygiene procedures, medical and surgical treatment.

Doxycycline is an antibiotic that has been successfully used in the treatment of periodontal disease. It penetrates the gum tissue and prevents the growth of bacteria that cause inflammation of the gums and lead to tooth decay.

Studies have shown that doxycycline can significantly improve the condition of gums and periodontal tissues. It can be used both in monotherapy and in combination with other drugs.

However, before starting treatment with doxycycline, it is necessary to conduct an accurate diagnosis and identify the causative agent of the disease. You should also consider possible side effects when using it, such as allergic reactions, dysbacteriosis and others.

Prescription of the drug in the treatment of postoperative wounds

Doxycycline is one of the most effective antibiotics in the treatment of postoperative wounds in dentistry. After surgery in the oral cavity, it is necessary to reduce the risk of developing inflammatory processes and infections that can lead to complications.

Doxycycline has a broad spectrum of antimicrobial activity and rapidly penetrates tissues. The drug kills both gram-positive and gram-negative bacteria, preventing their prolonged reproduction in the surgical area.

Doxycycline is given as tablets or capsules to be taken for 5-7 days. The dosage and duration of the course depend on the severity of the patient’s postoperative condition. However, you should not use the drug without a doctor’s prescription, as the misuse of antibiotics can lead to negative health consequences.

Infection prevention drug use

Doxycycline is often used to prevent infection after dental procedures such as tooth extractions or implants. This is because some of these procedures can cause a bacterial infection in the blood, which can lead to serious consequences.

Doxycycline helps prevent infection by blocking protein synthesis in bacteria, making it difficult for them to grow and reproduce. In addition, it has a wide spectrum of activity and can fight many types of bacteria, including those that can cause infections in the mouth.

Doxycycline is usually taken 1-2 days before a dental procedure and continued for 3-5 days after. This allows you to sufficiently reduce the risk of infection. However, the drug should be taken only as directed by a doctor, as it has many side effects and improper use can lead to serious health complications.

Side effects of doxycycline in dental use

Doxycycline is widely used to treat infections in dentistry due to its antibacterial properties. However, the use of this drug may cause some side effects in patients.

The most common side effect of doxycycline is gastrointestinal dysbiosis, which causes diarrhea, nausea and vomiting. Other side effects may include headache, weakness, taste changes, and allergic reactions such as hives and swelling of the face.

With prolonged use of doxycycline, a fungal infection may develop, since the antibiotic destroys not only harmful, but also beneficial microorganisms in the body. In addition, doxycycline can cause photosensitivity, which means increased sensitivity to sunlight.

Doxycycline is not recommended for use during pregnancy and lactation as it may adversely affect fetal development or lactation. Also, doxycycline should not be taken with antacids and fatty foods, as this reduces the absorption of the drug in the body.

If side effects occur while using doxycycline, you should immediately stop taking it and consult a doctor to find a more appropriate treatment. Self-medication and prolonged use of the drug can worsen the general state of health and cause serious complications.

Contraindications for the use of the drug

Doxycycline is one of the most effective drugs for the treatment of infectious diseases, including dental problems. However, before using the drug, it is necessary to familiarize yourself with its contraindications, which may vary depending on the patient and his state of health.

Allergy to tetracyclines: in the presence of allergic reactions to drugs of the tetracycline group, doxycycline should also not be used.

Pregnancy and breastfeeding: doxycycline may adversely affect the health of the fetus and infant, so it is not recommended to use the drug during pregnancy and breastfeeding.

Diseases of the liver and kidneys: in the presence of diseases of these organs, it is necessary to take doxycycline with some caution and only when prescribed by your doctor.

Use with certain drugs: Some groups of drugs and dietary supplements may affect the effectiveness of doxycycline, so before using the drug, you should read the list of possible unwanted interactions and consult your doctor.

If at least one of the listed contraindications is present, doxycycline should not be used and be sure to consult a doctor for advice and alternative treatment.

Interactions of doxycycline with other drugs

Doxycycline has the potential to interact with certain drugs, which may lead to poor treatment outcome or unwanted side effects. Therefore, before starting treatment, it is necessary to familiarize yourself with the list of pharmaceuticals that are incompatible with doxycycline.

There is a risk of increasing the toxicity of doxycycline with concomitant use of other antibiotics, drugs that increase the level of magnesium in the blood, iron and calcium, non-ejectable bases.

In the presence of diseases of the gastrointestinal tract, it is necessary to interact with the anesthetist and other specialists in order to select the correct drugs and dosages.

• Interaction with antibiotics.
• Interaction with drugs that increase the level of magnesium in the blood.
• Interaction with drugs that increase iron and calcium levels.
• Interaction with non-ejectable bases.

Doxycycline storage rules

Doxycycline is a drug that needs to be stored properly in order to remain effective. Here are the basic rules to follow:

• Store in a dry place. Doxycycline must be stored in a dry place to avoid exposure of the drug to moisture.
• Keep away from light. Light may degrade doxycycline, so the drug should be stored away from direct sunlight.
• Keep out of reach of children. Medicines should be kept out of the reach of children.