A continuing shortage of doxycycline means the drug should be used only for conditions that have no alternative treatments, the CDC advised this week.
Manufacturing issues and increased demand have resulted in drug shortages of some formulations of doxycycline -- including doxycycline hyclate and doxycycline monohydrate -- since Jan. 18, 2013, according to an agency statement. The drug is available from most manufacturers currently, but healthcare professionals may need to find new contacts to order supplies.
Additionally, the intravenous formulation of doxycycline hyclate and the oral suspension doxycycline calcium have not been subject to the shortage.
The CDC recommended that healthcare professionals limit use of the short-supply drugs to the following uses:
- Treatment of rickettsial infections
- Prophylaxis against Lyme disease following a tick bite
- Prophylaxis and treatment of malaria, "according to the standard recommendations"
The agency also noted that alternative treatments exist for STDs and Lyme disease and that providers "should use clinical judgment in making treatment and prophylactic decisions."
In rickettsial infections, such as Rocky Mountain spotted fever and anaplasmosis, patients of all ages should receive doxycycline to prevent severe morbidity and mortality. The CDC warned that delaying treatment until test results are in is "highly contraindicated." Other broad-spectrum antibiotics are ineffective at treating such conditions. Chloramphenicol should be used as an alternative only if a patient has a specific, life-threatening contraindication to doxycycline.
Although there are no other drugs that act as an effective prophylaxis against Lyme disease, the agency noted that alternatives for treatment of the disease include amoxicillin and cefuroxime axetil.
To determine the best course for prevention and treatment of malaria, the CDC referred healthcare professionals to its , noting that there are several drugs that are effective prophylactics and treatments for the condition.
"Healthcare professionals should ensure they have access to doxycycline for the listed indications, and advance planning is essential to ensure treatment is not delayed," the agency said, adding that sites that cannot access supplies or that find prices raised during the shortage seek alternate distributors, contact manufacturers directly, or contact state health officials.
Updates on drug shortages are available on the American Society of Health-System Pharmacists .