Doxycycline in the treatment of tick-borne infections in children

Doxycycline belongs to the group of tetracyclines and has a bacteriostatic effect. Compared to the antibiotic in the same group, tetracycline, it has greater bioavailability, a longer half-life and a more favorable profile of adverse drug reactions, i.e. when used Damage to tooth enamel is less likely to occur. Another advantage of the drug is the possibility of taking it together with food, including milk, which is important in the treatment of young children with the inaccessibility of liquid dosage forms. The role of doxycycline in the treatment of childhood infections is unique.

Doxycycline is considered the antibiotic of choice in the treatment of Rocky Mountain spotted fever (PLSH) and other rickettsial diseases, ehrlichiosis and Lyme disease in children and adults (as recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), USA). It is also recommended for the treatment of older children and adults infected with Bacillus anthracis.

Until 1991, chloramphenicol was considered the antibiotic of choice in the treatment of rickettsial diseases in children under 8 years of age, but the absence of a liquid dosage form for oral administration, the hematotoxicity associated with chloramphenicol, as well as new studies which have shown the minimal harmful effect of doxycycline on tooth enamel, have led to a modification of this standard.

The efficacy of doxycycline in the treatment of rickettsial disease is quite high, but it is directly linked to the speed of diagnosis and prescription of antibiotics. Thus, the mortality rate in children who started receiving doxycycline treatment in the first 4 days after the onset of symptoms was 2% compared to 6% in children whose treatment was started at a later date. Another study found an increase in mortality from 6.5% in children whose treatment was started in the first 5 days to 22.9% in children whose treatment was started at a later date. However, as a number of studies show, doctors are prejudiced against prescribing doxycycline to pediatric patients, which is completely unjustified.

Doxycycline is the drug of choice in the treatment of early localized forms of Lyme disease, it is also often used in the treatment of common and late forms of infection. Currently, it is not recommended to use this medication in children under 8 years of age due to the potential risk of damage to tooth enamel, in which amoxicillin is considered the drug of choice.

As part of the increasing incidence of bioterrorism, specialists from the Centers for the Control and Prevention of Infectious Diseases (CDC, USA) have developed recommendations for the prevention and treatment of anthrax. In these recommendations, ciprofloxacin and doxycycline are given as equivalent drugs of choice, regardless of the age of the patients. The choice of drug should be made taking into account bioavailability and tolerance. In patients exposed to systemic or inhalation exposure, additional antibacterial drugs may be used.

Doxycycline is available in the form of tablets, capsules of 50, 70 and 100 mg, in bottles of 100 and 200 mg for injection, as well as in liquid dosage forms (suspension and syrup) for oral administration.

For adolescents and adult patients, the recommended dose of doxycycline is 100 mg every 12 hours. For children, the recommended dose is 2 to 4 mg / kg / day (up to 200 mg / day) in 2 divided doses. Treatment is continued for at least 1 week with PLL and 2 to 3 months with Lyme disease.

When Bacillus anthracis is infected, treatment with doxycycline is carried out for 60 days according to the following schedules: