Doxycycline versus Minocycline

Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch

Difference between Doxycycline and Minocycline

	Doxycycline	Minocycline
Drug class	Tetracycline antibiotic
Activities	Antimicrobial, anti-inflammatory, neuroprotective 4, cytoprotective 5
Plasma half-life	18 hours	16 hours
Spectrum of activity		Minocycline is active against some strains of staphylococci 3 and H. influenzae resistant to other tetracyclines (due to its ability to penetrate the cells sufficiently to reach inhibiting concentrations).
Side effects, safety	Doxycycline has fewer reported side effects2. Gastrointestinal discomfort and photosensitivity are notably more common with doxycycline.	May cause vestibular dysregulation (vertigo, incoordination, lightheadedness), nausea, and vomiting. Minocycline may cause serious adverse effects, including serum sickness-like reaction, hypersensitivity syndrome reaction, drug-induced lupus, benign intracranial hypertension, and irreversible tissue pigmentation. More likely to cause elevated intracranial pressure.
Special populations	Pregnancy category D
Drug interactions	Decreased absorption with antacids, iron, and zinc.
Food interactions	Food reduces absorption of doxycycline by 20%.	Food reduces absorption of minocycline by 12%.
Lipophilicity, permeability	Highly lipophilic	Minocycline is 5-fold more lipophilic than doxycycline. In contrast to doxycycline, minocycline concentrations in skin are 47% higher than in serum because minocycline rapidly mobilizes from the blood into tissues, including lipid-rich tissues 1. The volume of distribution with minocycline is higher than with doxycycline. Superior ability to cross the blood-brain barrier.

Doxycycline vs Minocycline for Acne

Generally, doxycycline and minocycline offer comparable efficacy in the treatment of acne8. Both antibiotics are very lipophilic and reach significant drug levels in the pilosebaceous unit.

While minocycline has been proven to be as effective as doxycycline for the quantitative reduction of inflammatory acne lesions, it is considered by some practitioners to produce a more rapid and sustained clinical improvement.

Also, there is evidence that minocycline exhibits lower prevalence of Propionibacterium acnes resistance compared with other antibiotics 6.

Results of randomized comparison of doxycycline versus minocycline in acne vulgaris7	Doxycycline	Minocycline
Regimen	50 mg daily for 12 weeks	100 mg daily for 12 weeks
Cure or improvement of acne	78%	82%
Rate of unsatisfactory therapeutic results	22%	18%

Doxycycline vs Minocycline for Lyme Neuroborreliosis

Minocycline and doxycycline may have a dual therapeutic effect in Lyme disease -- in addition to their antimicrobial action they can exert control over the inflammatory effects elicited by B. burgdorferi spirochetes10. These antibiotics may promote central nervous system cell survival and attenuate multiple processes involved in mediating inflammation and cell death.

Minocycline is more lipid soluble than doxycycline, and is a potential alternative for treatment of Lyme neuroborreliosis9. Because minocycline is so highly lipid soluble, 100 mg twice daily is comparable with 400-mg daily doses of doxycycline in terms of CNS concentrations.

Although doxycycline and minocycline attain comparable serum levels, there are important differences in CSF and CNS concentrations. The high lipid solubility of minocycline may cause vestibular side effects, limiting the administration of minocycline to 100 mg twice daily rather than 200 mg twice daily. Because of this, doxycycline (400 mg daily) remains the preferred antibiotic for treatment of Lyme neuroborreliosis. For patients for whom treatment fails, minocycline may be a therapeutic option9.

Minocycline may permit a shorter duration of treatment in Lyme neuroborreliosis than high dose oral doxycycline because of its excellent CNS penetration9.

Doxycycline vs Minocycline for Rosacea

Results of trial comparing doxycycline versus minocycline in the treatment of rosacea7	Doxycycline	Minocycline
Regimen	40 mg daily for 16 weeks	100 mg daily for 16 weeks
At week 16, the median change in rosacea lesion count	13 lesions less	14 lesions less
At week 16, Investigator Global Assessment success ("clear" or "near clear")	17.5%	60%
Relapses rate at week 28	48%	6.7%

References

1. Macdonald H, Kelly RG, Allen ES, et al. Pharmacokinetic studies on minocycline in man. Clin Pharmacol Ther. 1973;14:852–861.
2. Smith K, Leyden JJ. Safety of doxycycline and minocycline: a systematic review. Clin Ther. 2005 Sep;27(9):1329-42. PubMed
3. Minuth JN, Holmes TM, Musher DM. Antimicrob Agents Chemother. 1974 Oct;6(4):411-4
4. Bernardino AL1, Kaushal D, Philipp MT. The antibiotics doxycycline and minocycline inhibit the inflammatory responses to the Lyme disease spirochete Borrelia burgdorferi. J Infect Dis. 2009 May 1;199(9):1379-88 PubMed
5. Schwartz J, Holmuhamedov E, Zhang X, Lovelace GL, Smith CD, Lemasters JJ. Minocycline and doxycycline, but not other tetracycline-derived compounds, protect liver cells from chemical hypoxia and ischemia/reperfusion injury by inhibition of the mitochondrial calcium uniporter. Toxicol Appl Pharmacol. 2013 Nov 15;273(1):172-9. PubMed
6. González R, Welsh O, Ocampo J, Hinojosa-Robles RM, Vera-Cabrera L, Delaney ML, Gómez M. In vitro antimicrobial susceptibility of Propionibacterium acnes isolated from acne patients in northern Mexico. Int J Dermatol. 2010 Sep;49(9):1003-7. PubMed
7. Laux B. A comparison of doxycycline versus minocycline. Hautarzt. 1989 Sep;40(9):577-81 PubMed
8. Kircik LH. Doxycycline and minocycline for the management of acne: a review of efficacy and safety with emphasis on clinical implications. J Drugs Dermatol. 2010 Nov;9(11):1407-11. PubMed
9. Cunha BA. Minocycline versus doxycycline in the treatment of Lyme neuroborreliosis. Clin Infect Dis. 2000 Jan;30(1):237-8. Full text
10. Bernardino AL, Kaushal D, Philipp MT. The antibiotics doxycycline and minocycline inhibit the inflammatory responses to the Lyme disease spirochete Borrelia burgdorferi. J Infect Dis. 2009 May 1;199(9):1379-88. Full text
11. van der Linden MM, van Ratingen AR, van Rappard DC, Nieuwenburg SA, Spuls PI. Doxycycline 40mg vs minocycline 100mg in the treatment of rosacea: a randomised, single blinded, non-inferiority trial, comparing efficacy and safety. Br J Dermatol. 2016 Oct 31. PubMed