Doxycycline versus Tetracycline
Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch
Doxycycline advantages over Tetracycline
- Doxycycline has more rapid and complete gastrointestinal absorption and higher bioavailability than tetracycline.
- Less dietary restrictions. Doxycycline can be taken with food because its absorption is not affected by food. Tetracycline absorption is affected by concurrent consumption of dairy products, food or heavy metals.
- Doxycycline is more lipophilic and as a result achieves higher tissue and intracellular concentrations.
- Doxycycline does not accumulate in patients with renal impairment.
- Doxycycline has more convenience of dosage schedule.
- Doxycycline is potentially less hepatotoxic than tetracycline1.
- Doxycycline has cytoprotective properties and can protect liver cells from ischemic and hypoxic injury5.
Tetracycline advantages over Doxycycline
- Reasonable efficacy.
- Low cost.
- Tetracycline is available in topical formulations.
- Tetracycline is less phototoxic.
Difference between Doxycycline and Tetracycline
Table 1. Comparison of Doxycycline and Tetracycline
|Vibramycin®, Doryx®, Oracea®, Periostat®||Sumycin®, Actisit®|
• Capsules, delayed-release
• Injection IV
• Tablets, delayed-release
• Periodontal extended-release liquid
• Topical solution, ointment, cream
|Tetracyclines have essentially the same broad antimicrobial activity:
• Wide range of gram-positive and gram-negative bacteria
• Atypical pathogens, including Chlamydia spp, Mycoplasma pneumonia, Rickettsia spp., Borrelia spp., Treponema spp., Vibrio cholerae
• Protozoan parasites
• Doxycycline is more active against staphylococci than tetracycline4
|Mechanism of action|
• Tetracyclines are bacteriostatic and work by inhibiting protein synthesis.
• Tetracyclines suppress the synthesis and activity of inflammatory mediators such as metalloproteinases2, prostaglandins, nitric oxide, and cytokines.
|• 18 to 22 hours||• 6 to 12 hours,
in patients with severe renal impairment up to 30 - 79 hours
|• ∼95% (reduced at high gastric pH)||• 75%|
|• Doxycycline is eliminated by the gastrointestinal tract and by the kidneys3. It is excreted as unchanged drug in the feces and urine.||• Tetracycline is mainly eliminated by the kidneys via glomerular filtration.|
|• Hypersensitivity to any of tetracycline antibiotics|
|• Hepatotoxicity is rare, occurs more commonly with tetracycline than with doxycycline
• Yellow-gray to brown discoloration of teeth during tooth development, enamel hypoplasia
• Esophagitis and esophageal ulceration
|• Abdominal discomfort
• Abdominal discomfort or pain
• Epigastric distress
• Excessive tetracycline accumulation may occur in patients with renal impairment.
|• Antacids - decreased absorption of doxycycline.||• Gastrointestinal absorption of tetracycline is reduced by about 50% by food or milk.
• Antacids - decreased absorption of tetracycline.
Doxycycline vs Tetracycline for Rosacea
Both tetracycline and doxycycline are considered first-line oral medications for rosacea 6 . However, only doxycycline is FDA approved for rosacea treatment.
Tetracyclines reduce inflammation, capillary vasodilation and leakage, and improve connective tissue integrity. Subantimicrobial dose tetracyclines produce anti-inflammatory action without promoting bacterial resistance.
Both tetracycline and doxycycline are effective for management of ocular rosacea 3.
|Results of comparison of doxycycline and tetracycline in ocular rosacea 7||Doxycycline||Tetracycline|
|Regimen||100 mg per day||1000 mg per day|
|Symptomatic relief after 6 weeks||greater with tetracycline|
|Symptomatic relief after 3 months||
no significant difference
|Gastrointestinal tract side effects||12.5%
(2 of 16 patients)
(3 of 8 patients)
Tetracycline dosage for rosacea: 250 mg to 500 mg twice daily for 6 to 12 weeks.
Doxycycline dosage for rosacea: 40 mg to 100 mg once daily for 6 to 12 weeks.
Doxycycline vs Tetracycline for Lyme disease
Tetracycline and doxycycline have excellent activity against spirochete Borrelia burgdorferi8.
Both antibiotics are effective for Lyme disease associated with erythema migrans9. However, doxycycline is preferred to tetracycline, particularly in patients with early disseminated disease. Doxycycline has better microbiologic activity and reaches higher cerebrospinal fluid concentrations. Additionally, doxycycline is effective for human granulocytic ehrlichiosis, which may occur simultaneously with early Lyme disease.
Doxycycline vs Tetracycline for Scrub typhus
Both medications are very effective for the treatment of scrub typhus and prevention of relapses 10.
|Results of comparative study 10||Doxycycline||Tetracycline|
|Dosage regimen||100 mg twice daily for 3 days||500 mg 4 times daily for 7 days|
|Scrub typhus cure rate||93.9%||100%|
|Time required for abatement of typhoid fever or for the alleviation of symptoms was similar|
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Published: December 01, 2017
Last updated: December 01, 2017