====== Doxycycline for Blepharokeratoconjunctivitis in Children ======
  * Avoid in younger than age 8 due to concern about teeth yellowing and enamel hypoplasia

===== Dosing =====
  * 40-200 mg/day have been used
    * most evidence for 100 mg QD x 3 months or 50 mg QD x 8 months 
    * 20 mg tabs BID x 8 weeks may have less side effects
  * Duration: 4 weeks to 8 months 
===== Side Effects =====
  * Skin: maculopapular and erythematous rash, photosensitivity and lesions 
    * Stevens-Johnsons syndrome rare
  * GI: (most common) nausea, emesis, diarrhea, glossitis, esophagitis dysphagia, dyspepsia enterocolitis, rarely pancreatitis 
  * Hepatotoxicity, dose related rise in BUN
  * Renal toxicity 
  * Blood: hemolytic anemia, thrombocytopenia, neutropenia, eosinophilia
  * CNS: Intracranial hypertension
  * Discolorations:  tooth enamel- maybe permanent in primary teeth,  reversable in adult teeth.  Browning of the thyroid gland (microscopic) without functional problems. 
  * Psychiatric: depression, anxiety, suicidal ideation, insomina, hallucinations, abnormal dreams. 

  * Supratheraputic INR in those taking coumadin 
===== Contraindications =====
  * pregnancy
  * nursing mothers
  * <8 years old

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[[https://www.aaojournal.org/article/S0161-6420(15)01303-2/pdf|Oral Antibiotics for Meibomian Gland-Related Ocular Surface Disease]]\\
[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390373/|The end of a dogma: the safety of doxycycline use in young children for malaria treatment]]
{{tag>drugs, blepharitis}}