The Food and Drug Administration (FDA) originally reported a shortage of some forms of doxycycline (doxycycline hyclate) and unavailability of tetracycline on Jan. 18, 2013, caused by increased demand and manufacturing issues. The FDA continues to report shortage from some, but not all, manufacturers of some dosages and forms of doxycycline hyclate and doxycycline monohydrate. The FDA does not currently report a shortage of intravenous doxycycline hyclate or the oral suspension doxycycline calcium commonly used in pediatric patients.
For additional information about the availability of doxycycline, visit the FDA Drug Shortage website.
Doxycycline is a broad-spectrum, bacteriostatic antibiotic used to treat a variety of diseases. For many indications, doxycycline is one of several options available for patients. However, for rickettsial infections, doxycycline is the treatment of choice. No data are available to recommend minocycline as an equally effective alternative to doxycycline for any of the diseases mentioned. Additionally, the spectrum of adverse effects with minocycline is higher than that for doxycycline. Tetracycline may be a suitable alternative for some diseases and indications; however, a similar shortage of tetracycline has been reported.
1. Doxycycline should be used to treat suspected rickettsial infections; no alternatives can be recommended that have the same proven degree of efficacy in limiting fatal outcome. Because treatment delay can result in adverse or fatal outcome, planning for doxycycline availability is essential.
2.Doxycycline is the recommended drug for prophylaxis of Lyme disease; alternatives have not been tested for efficacy. Providers should be judicious in its use following a tick bite.
3. Doxycycline should still be used for the prophylaxis and treatment of malaria according to the standard recommendations.
4. Alternatives exist for the treatment of STDs and Lyme disease. Providers should use clinical judgment in making treatment and prophylactic decisions. Refer to the links in the section below.
Doxycycline is currently available from most manufacturers, although providers may need to explore new contracts for procurement; projected return to availability for the one manufacturer reporting a shortage is uncertain, but is currently projected by September 2013, based on information provided by the FDA.
Healthcare professionals should ensure they have access to doxycycline for the listed indications, and advance planning is essential to ensure treatment is not delayed. Those who encounter difficulty ordering doxycycline or increased pricing from their usual suppliers should contact alternate distributors or directly contact the manufacturers. In circumstances where outages and increased pricing occur, healthcare professionals should contact their state health department to inquire about other procurement options.