September 1, 2015
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Vibramycin IV

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Vibramycin Intravenous




CLINICAL PHARMACOLOGY

Tetracyclines are readily absorbed and are bound to plasma proteins in varying degree. They are concentrated by the liver in the bile, and excreted in the urine and feces at high concentrations and in a biologically active form.

Following a single 100 mg dose administered in a concentration of 0.4 mg/mL in a onehour infusion, normal adult volunteers average a peak of 2.5 mcg/mL, while 200 mg of a concentration of 0.4 mg/mL administered over two hours averaged a peak of 3.6 mcg/mL. Excretion of doxycycline by the kidney is about 40 percent/72 hours in individuals with normal function (creatinine clearance about 75 mL/min.). This percentage excretion may fall as low as 1-5 percent/72 hours in individuals with severe renal insufficiency (creatinine clearance below 10 mL/min.). Studies have shown no significant difference in serum half-life of doxycycline (range 18-22 hours) in individuals with normal and severely impaired renal function.

Hemodialysis does not alter this serum half-life of doxycycline.

Microbiology

Doxycycline inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. Doxycycline has bacteriostatic activity against a broad range of Gram-positive and Gramnegative bacteria. Cross resistance with other tetracyclines is common.

Doxycycline has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section of the package insert for VIBRAMYCIN.

Gram-Negative Bacteria

Acinetobacter species
Bartonella bacilliformis

Brucella
species
Klebsiella
species
Klebsiella granulomatis

Campylobacter fetus

Enterobacter aerogenes

Escherichia coli

Francisella tularensis

Haemophilus ducreyi

Haemophilus influenzae

Neisseria gonorrhoeae

Shigella species

Vibrio cholerae

Yersinia pestis

Gram-Positive Bacteria

Bacillus anthracis
Streptococcus pneumoniae

Anaerobic Bacteria

Clostridium species
Fusobacterium fusiforme

Propionibacterium acnes

Other Bacteria

Nocardiae and other aerobic Actinomyces species
Borrelia recurrentis
Chlamydophila psittaci

Chlamydia trachomatis

Mycoplasma pneumoniae

Rickettsiae

Treponema pallidum

Treponema pallidum subspecies pertenue

Ureaplasma urealyticum

Parasites

Balantidium coli
Entamoeba species
Plasmodium falciparum*

*Doxycycline has been found to be active against the asexual erythrocytic forms of Plasmodium falciparum, but not against the gametocytes of P. falciparum. The precise mechanism of action of the drug is not known.

Susceptibility Testing Methods

When available, the clinical microbiology laboratory should provide the results of in vitro susceptibility test results for antimicrobial drugs used in resident hospitals to the physician as periodic reports that describe the susceptibility profile of nosocomial and community-acquired pathogens. These reports should aid the physician in selecting the most effective antimicrobial.

Dilution Techniques

Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations (MICs). These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized test method1,2,4 (broth or agar). The MIC values should be interpreted according to criteria provided in Table 1.

Diffusion techniques

Quantitative methods that require measurement of zone diameters can also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. The zone size provides an estimate of the susceptibility of bacteria to antimicrobial compounds. The zone size should be determined using a standardized test method1,3,4. This procedure uses paper disks impregnated with 30-μg doxycycline to test the susceptibility of microorganisms to doxycycline. The disk diffusion interpretive criteria are provided in Table 1.

Anaerobic Techniques

For anaerobic bacteria, the susceptibility to doxycycline can be determined by a standardized test method5. The MIC values obtained should be interpreted according to the criteria provided in Table 1.

Table 1: Susceptibility Test Interpretive Criteria for Doxycycline and Tetracycline

Bacteriaa Minimal Inhibitory Concentration
(mcg/mL)
Zone Diameter
(mm)
Agar Dilution
(mcg/mL)
S I R S I R S I R
Acinetobacter spp.
  Doxycycline ≤ 4 8 ≥ 16 ≥ 13 10-12 ≤ 9 - - -
  Tetracycline ≤ 4 8 ≥ 16 ≥ 15 12-14 ≤ 11 - - -
Anaerobes
  Tetracycline - - - - - - ≤ 4 8 > 16
Bacillus anthracisb
  Doxycycline ≤ 1 - - - - - - - -
  Tetracycline ≤ 1 - - - - - - - -
Brucella speciesb
  Doxycycline ≤ 1 - - - - - - - -
  Tetracycline ≤ 1 - - - - - - - -
Enterobacteriaceae
  Doxycycline ≤ 4 8 ≥ 16 ≥ 14 11-13 ≤ 10 - - -
  Tetracycline ≤ 4 8 ≥ 16 ≥ 15 12 -14 ≤ 11 - - -
Franciscella tularensishb
  Doxycycline ≤ 4 - - - - - - - -
  Tetracycline ≤ 4 - - - - - - - -
Haemophilus influenzae
  Tetracycline ≤ 2 4 ≥ 8 ≥ 29 26-28 ≤ 25 - - -
Mycoplasma pneumomaeb
  Tetracycline - - - - - - ≤ 2 - -
Nocardiae and other aerobic Actinomyces speciesb
  Doxycycline ≤ 1 2- 4 ≥ 8 - - - - - -
Neisseria gonorrhoeaec
  Tetracycline - - - ≥ 38 31-37 ≤ 30 ≤ 0.25 0.5-1 > 2
Streptococcus pneumoniae
  Doxycycline ≤ 0.25 0.5 ≥ 1 ≥ 28 25-27 ≤ 24 - - -
  Tetracycline ≤ 1 2 ≥ 4 ≥ 28 25-27 ≤ 24 - - -
Vibrio cholerae
  Doxycycline ≤ 4 8 ≥ 16 - - - - - -
  Tetracycline ≤ 4 8 ≥ 16 - - - - - -
Yersinia pestis
  Doxycycline < 4 8 ≥ 16
  Tetracycline < 4 8 ≥ 16 - - - - - -
Ureaplasma urealyticum
  Tetracycline - - - - - - ≥ 1 - ≥ 2
a Organisms susceptible to tetracycline are also considered susceptible to doxycycline. However, some organisms that are intermediate or resistant to tetracycline may be susceptible to doxycycline
b The current absence of resistance isolates precludes defining any results other than “Susceptible”. If isolates yielding MIC results other than susceptible, they should be submitted to a reference laboratory for further testing.
c Gonococci with 30 mcg tetracycline disk zone diameters of < 19 mm usually indicate a plasmid-mediated tetracycline resistant Neisseria gonorrhoeae isolate. Resistance in these strains should be confirmed by a dilution test (MIC ≥ 16 mcg/mL)

A report of “Susceptible” (S) indicates that the antimicrobial drug is likely to inhibit growth of the microorganism if the antimicrobial drug reaches the concentration usually achievable at the site of infection. A report of Intermediate (I) indicates that the result should be considered equivocal, and, if the bacteria is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug product is physiologically concentrated or in situations where high dosage of drug can be used. This category also provides a buffer zone that prevents small uncontrolled technical factors from causing major discrepancies in interpretation. A report of Resistant (R) indicates that the antimicrobial is not likely to inhibit growth of the pathogen if the antimicrobial drug reaches the concentrations usually achievable at the infection site; other therapy should be selected.

Quality Control

Standardized susceptibility test procedures require the use of laboratory controls to monitor and ensure the accuracy and precision of the supplies and reagents used in the assay, and the techniques of the individuals performing the test1,2,3,4,5,6,7. Standard doxycycline and tetracycline powders should provide the following range of MIC values noted in Table 2. For the diffusion technique using the 30 mcg doxycycline disk the criteria noted in Table 2 should be achieved.

Table 2: Acceptable Quality Control Ranges for Susceptibility Testing for Doxycycline and Tetracycline

QC Strain Minimal Inhibitory Concentration (mcg/mL) Zone Diameter (mm) Agar Dilution (mcg/mL)
Enterococcusfaecalis ATCC 29212
  Doxycycline 2 - 8 - -
  Tetracycline 8 - 3 2 - -
Escherichia coli ATCC 25922
  Doxycycline 2 1 0. 8 - 2 4 -
  Tetracycline 0.5 -2 18 -25 -
Eubacteria lentum ATCC 43055
  Doxycycline 2 - 16
Haemophilus influenzae ATCC 49247
  Tetracycline 4 -32 14 -22 -
Neisseriagonorrhoeae ATCC 49226
  Tetracycline - 2 4 - 0 3 0.25 - 1
Staphylococcus aureus ATCC 25923
Doxycycline - 23    -29 -
   Tetracycline - 24    -30 -
Staphylococcus aureus ATCC 29213
  Doxycycline 0.12 -0.5 - -
  Tetracycline 0.12 - 1 - -
Streptococcus pneumoniae ATCC 49619
  Doxycycline 0.015 -0.12 25 -34 -
  Tetracycline 0.06 -0.5 27 - 31 -
Bacteroides fragilis ATCC 25285
  Tetracycline - - 0.12 -0.5
Bacteroides thetaiotaomicron ATCC 29741
  Doxycycline 2 -16 - -
  Tetracycline - - 8 -32
Mycoplasma pneumoniae ATCC 29342
  Tetracycline 0.06-0.5 - 0.06-0.5
Ureaplasma urealyticum ATCC 33175
  Tetracycline - - > 8

REFERENCES

1. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement, CLSI document M100-S24. CLSI document M100-S24, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2014.

2. Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically; Approved Standard - Ninth Edition. CLSI document M07-A9, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2012.

3. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Diffusion Susceptibility Tests; Approved Standard – Eleventh Edition CLSI document M02-A11, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2012.

4. Clinical and Laboratory Standards Institute (CLSI). Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria; Approved Guideline – Second Edition CLSI document M45-A2, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2010.

5. Clinical and Laboratory Standards Institute (CLSI). Methods for Antimicrobial Susceptibility Testing of Anaerobic Bacteria; Approved Standard - Eighth Edition. CLSI document M11-A8. Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, PA 19087 USA, 2012.

6. Clinical and Laboratory Standards Institute. Susceptibility Testing of Mycobacteria, Nocardiae, and Other Aerobic Actinomycetes; Approved Standard—Second Edition. CLSI document M24-A2. Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, PA 19087 USA, 2011.

7. Clinical and Laboratory Standards Institute. Methods for Antimicrobial Susceptibility Testing for Human Mycoplasmas; Approved Guideline. CLSI document M43-A. Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, PA 19087 USA, 2011.

Last reviewed on RxList: 5/27/2015
This monograph has been modified to include the generic and brand name in many instances.

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