Doxycycline drug has a leading role in the treatment of chlamydial infections, acne and remains the drug of choice in the causal treatment of especially dangerous infections, rickettsial diseases and zoonoses (including in the treatment and prevention of anthrax.
We should also emphasize the ability of doxycycline affect the intracellular bacteria (Chlamydia spp., Mycoplasma spp., Ureaplasma spp., Legionella spp., Plasmodium spp., Family Rickettsiaceae, Francisella tularensis, Brucella spp.), That allows to achieve the therapeutic effect, when most of the other Antibiotics do not reach their goal. Doxycycline is widely used in gynecological practice in the treatment of infections, sexually transmitted infections, nonspecific inflammatory diseases of the pelvic organs (PID), and includes all major antibiotic regimens PID. Doxycycline is an effective tool in cases of urogenital ureaplasmosis while to macrolides and fluoroquinolones in the last two decades have seen the growth of sustainability.
In the treatment of infections of the respiratory system doxycycline can be effectively used in cases of “atypical” disease etiology (C. pneumoniae, M. pneumoniae).
The penetration of the drug works in almost all tissues and organs, including bone, periosteum, teeth and periodontal does doxycycline antibacterial virtually irreplaceable in traumatology and periodontology.
Tetracycline antibiotics including doxycycline are also very popular in ophthalmology. It works very effective in the eye tissues and effectively inhibit the growth of pathogenic microorganisms, but also actively demonstrate anti-inflammatory properties.
In dermatology, doxycycline is the drug for treatment of Acne rosacea and Acne vulgaris, it is used as a reference for comparison with other drugs used in the treatment of this disease.
The downside of a wide spectrum and a high ability to penetrate the tissue is a large number of serious side effects of the whole group of tetracyclines.
We are talking about the impact of ulcerative tetracyclines on the mucosa of the esophagus. According to various data, from 50 to 70% of esophageal ulcers induced by administration of drugs associated with the reception of doxycycline, and other tetracyclines. According S.Bott and R.McCallum, half of all cases of esophagitis caused by drug tetracycline, doxycycline and clindamycin administration. Register drug esophagitis is low and estimated to be 3.9-4.0 cases per 100 thousand. Per year. Nevertheless, the incidence of drug esophagitis clearly underestimated because some patients symptoms cropped spontaneously or doctor does not establish a relationship between drug intake and the development of the clinical picture of erosions and ulcers of the esophagus.
- Damage of the esophageal mucosa doxycycline is only possible in the case of a local increase in the concentration of the drug in the lumen of the esophagus. The oral dosage form of doxycycline is presented in tablets and capsules containing doxycycline hydrochloride. The capsules may release the drug in the esophagus, and the hydrochloride salt of the drug is slowly dissolved to form a strongly acidic solution (pH 3.0). A particularly dangerous situation is receiving a capsule with a small amount of water: in this case gelatin capsule may stick to the surface of the esophagus. According to J.Kikendall, capsules remain in the esophagus 3 times longer as compared with tablets. Doxycycline hydrochloride tablets better overcome the esophagus, but somewhat slower drug release as compared with the capsules. In the case of dosing with too little water in the same manner as in the case of capsules, tablets passage through the esophagus significantly slows down to a delay in the esophagus (especially in anatomical narrowing), and wherein the gradual dissolution of the drug, accompanied by a local increase in acidity. The acidic environment is alien to the esophageal mucosa, sharp local acidification of the medium by dissolving the drug doxycycline hydrochloride causes damage to the mucous membrane, lined with sensitive neorogovevayuschy flat stratified epithelium, including the formation of erosions and in some cases, ulcers of the esophagus.
The clinical picture:
- The clinical picture of Doxycycline drug esophagitis prevalent complaints : pain when swallowing, chest pain and dysphagia. These three constitute the pathognomonic symptom triad in the drug damaged esophagus.
Treatment and prevention:
- Typically, removal of the drug is quite sufficient measure for the patient’s recovery. Resolution of symptoms usually occurs within a period of a few days to 3 weeks.
Patients must adhere to a diet, sparing the esophagus in the mechanical, thermal and chemical relationships, avoid alcohol, citrus fruits and other irritating foods. Strict conditions for the appointment of antacids, secretion blockers and others. Medicines clinical situation is not available. However, control of secretory activity of the gastric glands pathogenetically justified, since the reduction in acidity prevents further irritation of the ulcerated or eroded surface.
- It should inform the patient about the need to receive a large amount of doxycycline with water: wherein, in the first few sips should be done before dosing and after swallowing tablets or capsules should be washed down with it at least a glass (200 ml) of water. Second, the patient must take the medication standing or sitting and should not occupy a horizontal position for 2 hours after drug administration. Third, the patient should inform the doctor in case of heartburn, odynophagia, or dysphagia.
Advantages of doxycycline monohydrate:
- In contrast to the hydrochloride salt was hydrolysed doxycycline (doxycycline hydrochloride) practically neutral base doxycycline (doxycycline monohydrate) does not increase the acidity when dissolved. Of special note is that when using the medicament esophagitis doxycycline monohydrate was recorded.