Doxycycline for Skin Infections in Adults

Indications and Usage

The Infectious Diseases Society of America recommends doxycycline as a first-line oral antibiotic option for moderate to severe skin infections in adults, particularly when community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is suspected 1
Doxycycline is indicated for empirical coverage of CA-MRSA in outpatients with skin and soft tissue infections (SSTIs) 1
It is particularly useful for purulent cellulitis when empirical coverage for CA-MRSA is needed 1
Doxycycline can be used alone or in combination with a β-lactam (e.g., amoxicillin) when coverage for both β-hemolytic streptococci and CA-MRSA is desired 1

Standard dosing for skin infections is typically 100 mg twice daily 1
Treatment duration is usually 5-10 days for uncomplicated skin infections but should be adjusted based on clinical response 1
For hospitalized patients with complicated SSTIs, doxycycline can be administered intravenously 1

Doxycycline is effective for treating abscesses and other purulent skin infections, especially when CA-MRSA is suspected 1
It should be considered when patients do not respond to β-lactam therapy or show systemic toxicity 1
Beyond its antimicrobial effects, doxycycline has anti-inflammatory properties that make it effective for conditions like rosacea 2
Photosensitivity is more common with doxycycline compared to other tetracyclines 3, 4
Gastrointestinal disturbances occur frequently, especially at higher doses 3, 4
Contraindicated in children under 8 years of age due to potential dental staining 1

Concomitant therapy with benzoyl peroxide or a topical retinoid is recommended when using systemic antibiotics for acne to prevent resistance 5, 6
Systemic antibiotic use should be limited to the shortest possible duration (re-evaluate at 3-4 months) to minimize development of bacterial resistance 5, 6
For patients who cannot tolerate tetracyclines, alternative options include trimethoprim-sulfamethoxazole, clindamycin, or linezolid 1, 5
In hospitalized patients with complicated SSTIs, intravenous options include vancomycin, linezolid, daptomycin, telavancin, or clindamycin 1