Monodox

Drug overview for MONODOX (doxycycline monohydrate):

Generic name: DOXYCYCLINE MONOHYDRATE (dox-ee-SYE-kleen)
Drug class: Tetracyclines
Therapeutic class: Anti-Infective Agents

Doxycycline is a semisynthetic tetracycline antibiotic derived from oxytetracycline.

No enhanced Uses information available for this drug.

DRUG IMAGES

MONODOX 100 MG CAPSULE
MONODOX 50 MG CAPSULE
MONODOX 75 MG CAPSULE

The following indications for MONODOX (doxycycline monohydrate) have been approved by the FDA:

Indications:
Acne vulgaris
Actinomycosis
Acute gonococcal cervicitis
Acute gonococcal endometritis
Acute gonococcal epididymo-orchitis
Acute gonococcal urethritis
Acute lower genitourinary gonorrhea
Acute Staph. aureus sinusitis
Bacterial pneumonia
Bacterial urinary tract infection
Bartonellosis
Boutonneuse fever
Brucellosis
Campylobacter fetus infection
Chancroid
Chlamydial infections
Chloroquine-resistant Plasmodium falciparum malaria prevention
Cholera
Cutaneous anthrax
Disseminated gonococcal infection
Gastrointestinal anthrax
Genitourinary Chlamydia trachomatis infection
Gonococcal pharyngitis
Granuloma inguinale
Inclusion conjunctivitis caused by Chlamydia trachomatis
Inhaled anthrax
Listeriosis
Louse-borne typhus
Lymphogranuloma venereum
Malaria prevention
Murine typhus
Mycoplasmal pneumonia
Nongonococcal urethritis
Pharyngitis
Plague
Post-exposure anthrax prevention
Psittacosis
Q fever endocarditis
Q fever
Recrudescent typhus
Rectal Chlamydia trachomatis infection
Rectal gonorrhea
Relapsing fever
Rickettsial infection
Rickettsialpox
Rocky Mountain spotted fever
Scrub typhus
Sinusitis
Skin and skin structure infection
Syphilis
Trachoma
Tularemia
Typhus infections
Upper respiratory infection due to Haemophilus influenzae
Upper respiratory pneumococcal infection
Yaws

Professional Synonyms:
Acne simplex
Actinomycotic infection
Actinophytosis
Acute cervical gonococcal infection
Acute cervical gonorrhea
Acute cervical infection due to Neisseria gonorrhoeae
Acute epididymis/testes neisseria gonorrhoeae infection
Acute gonococcal infection of the epididymis and testes
Acute gonorrhea of the endometrium
Acute lower genitourinary tract gonococcal infection
Acute lower genitourinary tract gonorrhea
Acute lower GU tract Neisseria gonorrhoeae infection
Acute Neisseria gonorrhoeae infection of the endometrium
Acute sinusitis due to Staphylococcus aureus
Acute sinusitis due to Staphylococcus pyogenes aureus
Acute urethral gonococcal infection
Acute urethral gonorrhea
Acute urethral infection due to Neisseria gonorrhoeae
Akamushi disease
Anthrax pneumonia
Asiatic cholera
Bartonella bacilliformis infection
Bedsonia pneumonia
Bilious typhoid of Griesinger
Black fever - Rocky Mountain spotted fever
Black measles
Blue disease
Blue fever
Bouba
Brazilian spotted fever
Brill-Zinsser disease
Camp fever
Campylobacter fetus infectious disease
Carrion's disease
Chancroidal ulcer
Chlamydia infection
Chlamydia species infection
Chlamydia spp. infection
Chloroquine-resistant falciparum malaria prophylaxis
Chronic contagious microbial inflammation
Colombian tick fever
Common acne
Congo red fever
Congolian red fever
Conjunctivitis caused by chlamydia trachomatis
Contagious granular conjunctivitis
Deer-fly disease
Deer-fly fever
Disease caused by Rickettsia
Disseminated gonococcal infections
Disseminated gonorrhea
Disseminated Neisseria gonorrhoeae infection
Donovanosis
Eaton agent pneumonia
Egyptian ophthalmia
Endemic typhus
Endocarditis due to Coxiella burnetii
Epidemic typhus
Exanthematic typhus of Sao Paulo
Famine fever
Flea-borne typhus
Flood fever
Fourth venereal disease
Frambesia
Francis' disease
Genitourinary infection due to Chlamydia trachomatis
GI anthrax
Gonococcal arthritis-dermatitis syndrome
Gonococcal infection of the pharynx
Gonococcal proctitis
Granular lids
Granular ophthalmia
Granuloma venereum
Haemophilus influenzae upper respiratory infection
Hemophilus influenzae upper respiratory infection
Hemophilus influenzae URI
Inclusion blennorrhea
Inclusion conjunctivitis
Infection due to Calymmatobacterium granulomatis
Infection due to Listeria monocytogenes
Infection due to Rickettsia burnetii
Infection due to Rickettsia diaporica
Infection of skin and/or subcutaneous tissue
Infection of the pharynx due to neisseria gonorrhoeae
Infection of the rectum due to Neisseria gonorrhoeae
Inhalational anthrax
Intestinal anthrax
Inundation fever
Island disease
Island fever
Jail fever
Japanese river fever
Kedani fever
Kew Garden fever
Malaria chemoprophylaxis
Malta fever
Mexican spotted fever
Mite typhus
Ornithosis
Pahvant Valley fever
Pahvant Valley plague
Parangi
Parrot fever
Pharyngeal gonorrhea
Pian
Pinta fever
Pneumococcal upper respiratory tract infection
Post-exposure anthrax prophylaxis
Primary atypical pneumonia
Prophylaxis for malaria-prone areas
Pudendal ulcer
Query fever
Rabbit fever
Rag-Sorter's disease
Ragpicker's disease
Ragsorter's disease
Recrudescent typhus fever
Rectal infection due to Chlamydia trachomatis
Recurrent fever
Recurring infection due to Rickettsia prowazeki bacteria
Red fever
Sao Paulo fever
Sao Paulo typhus
Shimamushi disease
Ship fever
Simple acne
Sinuitis
Skin and soft tissue skin infection
Skin infection due to Bacillus anthracis
Spirillum fever
Throat inflammation
Tobia fever
Trachomatous follicular conjunctivitis
Tropical typhus
Tsutsugamushi disease
Tsutsugamushi Fever
Typhinia
Typhus fever
Typhus infection
Typhus
Undulant fever
Upper respiratory Diplococcus pneumoniae infection
Upper respiratory infection due to H. flu
Upper respiratory infection due to H. influenzae
Upper respiratory infection due to Pfeiffer's bacillus
Upper respiratory infection from Fraenkel's Pneumococcus
Upper respiratory Streptococcus pneumoniae infection
Upper respiratory tract infection due to Pneumococcus
Upper respiratory tract infection due to S. pneumoniae
URI due to Fraenkel-Weichselbaum Pneumococcus
Venereal ulcer
Vesicular rickettsiosis
Wool-Sorter's disease
Wool-Sorter's pneumonia
Woolsorter's disease

The following dosing information is available for MONODOX (doxycycline monohydrate):

Dosing
Administration
MONODOX
DOXYCYCLINE MONOHYDRATE

Dosage of doxycycline calcium, doxycycline hyclate, and doxycycline monohydrate is expressed in terms of doxycycline.

The usual oral dosage of doxycycline for adults is 100 mg every 12 hours on the first day of treatment, followed by 100 mg daily given in 1 or 2 divided doses. For severe infections, adults should receive 100 mg every 12 hours.

The usual oral dosage of doxycycline for children older than 8 years of age weighing more than 45 kg is 100 mg every 12 hours on the first day of treatment, followed by 100 mg daily given in 1 or 2 divided doses. Children older than 8 years of age weighing 45 kg or less should receive 4.4 mg/kg given in 2 divided doses on the first day of treatment, followed by 2.2

mg/kg daily given in 1 or 2 divided doses. For severe infections, children 8 years of age or older weighing more than 45 kg may receive 100 mg every 12 hours and those weighing 45 kg or less may receive up to 4.4 mg/kg daily.

The AAP states that oral doxycycline in inappropriate for severe infections.

The usual IV dosage of doxycycline for adults is 200 mg on the first day of treatment given in 1 or 2 infusions, followed by 100-200 mg daily. If a dosage of 200 mg daily is used, dosage should be given in 1 or 2 infusions.

The usual IV dosage of doxycycline for children older than 8 years of age weighing more than 45 kg is 200 mg on the first day of treatment given in 1 or 2 infusions, followed by 100-200 mg daily. If a dosage of 200 mg daily is used, dosage should be given in 1 or 2 infusions. The usual IV dosage for children older than 8 years of age weighing 45 kg or less is 4.4

mg/kg on the first day of treatment given in 1 or 2 infusions, followed by 2.2-4.4 mg/kg daily given in 1 or 2 infusions.

Unlike other currently available tetracycline derivatives, usual dosage of doxycycline may be used in patients with impaired renal function.

No enhanced Administration information available for this drug.

Dosing information for MONODOX
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
MONODOX 75 MG CAPSULE	Maintenance	Adults take 1 capsule (75 mg) by oral route once daily
MONODOX 100 MG CAPSULE	Maintenance	Adults take 1 capsule (100 mg) by oral route 2 times per day
MONODOX 50 MG CAPSULE	Maintenance	Adults take 1 capsule (50 mg) by oral route every 12 hours

Generic dosing information for DOXYCYCLINE MONOHYDRATE
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
DOXYCYCLINE MONO 50 MG CAP	Maintenance	Adults take 1 capsule (50 mg) by oral route every 12 hours
DOXYCYCLINE MONO 100 MG CAP	Maintenance	Adults take 1 capsule (100 mg) by oral route 2 times per day
DOXYCYCLINE MONO 75 MG CAPSULE	Maintenance	Adults take 1 capsule (75 mg) by oral route once daily

The following drug interaction information is available for MONODOX (doxycycline monohydrate):

Contraindicated
Severe
Moderate

There are 2 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction	Drug Names
Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)	VIVOTIF
Selected Retinoids (Systemic)/Tetracyclines SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Both systemic tetracyclines(1-4) and systemic retinoids(5-13) have been independently associated with medication-induced intracranial hypertension. CLINICAL EFFECTS: The concurrent use of oral retinoids(5-12) with tetracyclines has been associated with pseudotumor cerebri (benign intracranial hypertension). Early signs of pseudotumor cerebri include papilledema (inflammation of the optic nerve), headache, nausea, vomiting, and visual disturbances such as blurred vision, double vision, and loss of vision.(14) PREDISPOSING FACTORS: Women of childbearing age who are overweight or have a previous history of intracranial hypertension are at a greater risk of developing intracranial hypertension.(14) PATIENT MANAGEMENT: The UK(5) and US(6) manufacturers of acitretin state state that concurrent use with tetracyclines is contraindicated. The UK manufacturer of isotretinoin states that concurrent use with tetracyclines is contraindicated.(7) The US manufacturer of isotretinoin states that the concurrent use of tetracyclines should be avoided.(8) The US manufacturer of minocycline states that the administration of isotretinoin should be avoided shortly before, during and shortly after minocycline therapy.(2) The UK manufacturers of oral tretinoin and alitretinoin states that concurrent use with tetracyclines is contraindicated.(9,11) The Canadian manufacturer of palovarotene states that coadministration of tetracycline derivatives should be avoided.(12) Patients who present with symptoms of pseudotumor cerebri should be screened for papilledema. If papilledema is present, they should discontinue the drug and be referred to a neurologist for further treatment.(5-13) DISCUSSION: The concurrent use of isotretinoin and tetracyclines has been associated with pseudotumor cerebri.(5-13) A review of ocular side effects from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the Food and Drug Administration, and medical journals from 1979 to 2003 found 6 patients who developed intracranial hypertension while taking concurrent minocycline or tetracycline with tretinoin, acitretin, or etretinate.(13)	ABSORICA, ABSORICA LD, ACCUTANE, ACITRETIN, AMNESTEEM, CLARAVIS, ISOTRETINOIN, RETINOIC ACID, SOHONOS, TRETINOIN, TRETINOIN ACID, ZENATANE

Drug Interaction

Drug Names

Live Typhoid Vaccine/Antimicrobials

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1)

CLINICAL EFFECTS: Vaccination may be ineffective.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3)

DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)

VIVOTIF

Selected Retinoids (Systemic)/Tetracyclines

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Both systemic tetracyclines(1-4) and systemic retinoids(5-13) have been independently associated with medication-induced intracranial hypertension.

CLINICAL EFFECTS: The concurrent use of oral retinoids(5-12) with tetracyclines has been associated with pseudotumor cerebri (benign intracranial hypertension). Early signs of pseudotumor cerebri include papilledema (inflammation of the optic nerve), headache, nausea, vomiting, and visual disturbances such as blurred vision, double vision, and loss of vision.(14)

PREDISPOSING FACTORS: Women of childbearing age who are overweight or have a previous history of intracranial hypertension are at a greater risk of developing intracranial hypertension.(14)

PATIENT MANAGEMENT: The UK(5) and US(6) manufacturers of acitretin state state that concurrent use with tetracyclines is contraindicated. The UK manufacturer of isotretinoin states that concurrent use with tetracyclines is contraindicated.(7) The US manufacturer of isotretinoin states that the concurrent use of tetracyclines should be avoided.(8)

The US manufacturer of minocycline states that the administration of isotretinoin should be avoided shortly before, during and shortly after minocycline therapy.(2) The UK manufacturers of oral tretinoin and alitretinoin states that concurrent use with tetracyclines is contraindicated.(9,11) The Canadian manufacturer of palovarotene states that coadministration of tetracycline derivatives should be avoided.(12)

Patients who present with symptoms of pseudotumor cerebri should be screened for papilledema. If papilledema is present, they should discontinue the drug and be referred to a neurologist for further treatment.(5-13)

DISCUSSION: The concurrent use of isotretinoin and tetracyclines has been associated with pseudotumor cerebri.(5-13) A review of ocular side effects from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the Food and Drug Administration, and medical journals from 1979 to 2003 found 6 patients who developed intracranial hypertension while taking concurrent minocycline or tetracycline with tretinoin, acitretin, or etretinate.(13)

ABSORICA, ABSORICA LD, ACCUTANE, ACITRETIN, AMNESTEEM, CLARAVIS, ISOTRETINOIN, RETINOIC ACID, SOHONOS, TRETINOIN, TRETINOIN ACID, ZENATANE

There are 6 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Topical Tretinoin/Tetracyclines SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. CLINICAL EFFECTS: Concurrent use of topical tretinoin with tetracyclines may increase the risk of phototoxicity(1) in some patients.(2) PREDISPOSING FACTORS: Patients using topical tretinoin for the treatment of photodamage may be predisposed to photosensitivity.(2) PATIENT MANAGEMENT: Concurrent use of topical tretinoin and tetracycline is standard practice in the treatment of acne.(3) However, patients taking tetracyclines should not use topical tretinoin (e.g Renova) for the treatment of photodamage.(1,2) DISCUSSION: The concurrent use of topical tretinoin and tetracyclines may result in an increased risk of phototoxicity.(1,2)	KATARYA, KATARYAXN, KETARYA, KEVARYA, KUTARYAXM, KUTARYAXMPA, KUVARYA, KUVARYE, REFISSA, RENOVA, RENOVA PUMP, TRETINOIN, TRI-LUMA, YAXATARXYN, YOKATAR
Cholera Vaccine Live/Selected Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine.(1) CLINICAL EFFECTS: Concurrent or recent antibiotic use may make the cholera vaccine ineffective.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of live cholera vaccine states that it should not be administered to patients who have received antibiotics within 14 days prior to vaccination.(1) If antimalarial prophylaxis with chloroquine is required, administer the live cholera vaccine at least 10 days before beginning chloroquine.(1) Antibiotics linked to this monograph are: macrolides, quinolones, tetracyclines, ampicillin, cefprozil, chloramphenicol, furazolidone, sulfamethoxazole-trimethoprim, and sulfametrole-trimethoprim.(2,3) DISCUSSION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine, rendering the vaccine ineffective.	VAXCHORA ACTIVE COMPONENT, VAXCHORA VACCINE
Aminolevulinic Acid/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Aminolevulinic acid, anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are all known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of aminolevulinic acid in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1) DISCUSSION: Because of the risk of increased photosensitivity, the US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1)	AMINOLEVULINIC ACID HCL, GLEOLAN
Porfimer/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Porfimer causes photosensitivity due to residual drug which is present in all parts of the skin. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of porfimer in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: Patients with any hepatic impairment and patients with severe renal impairment have reduced drug elimination and may remain photosensitive for 90 days or longer.(1) PATIENT MANAGEMENT: The US manufacturer of porfimer states that concurrent use of porfimer with photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1) Since the photosensitive effect of porfimer may persist for at least 30 days (and for 90 days in some patients), it would be prudent to avoid other photosensitizing agents for at least 30 days after administration of porfimer. DISCUSSION: All patients who have received porfimer become photosensitive. It is unknown what the risk of photosensitivity reactions is when porfimer is used concurrently with other photosensitizing agents. When porfimer was used in clinical trials, photosensitivity reactions occurred in about 20% of cancer patients and in 69% of high-grade dysplasia in Barretts esophagus patients. Most of the reactions were mild to moderate erythema, but they also included swelling, pruritus, burning sensation, feeling hot, or blisters. The majority of reactions occurred within 90 days of porfimer administration.(1)	PHOTOFRIN
Methoxsalen/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Methoxsalen causes photosensitivity due to residual drug which is present in all parts of the skin from photopheresis. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of methoxsalen in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of methoxsalen states that concurrent use of methoxsalen with anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1) DISCUSSION: All patients who have received methoxsalen become photosensitive. It is unknown what the risk of photosensitivity reactions is when methoxsalen is used concurrently with other photosensitizing agents.(1)	METHOXSALEN, UVADEX
Fecal Microbiota Spores/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores.	VOWST

There are 5 moderate interactions. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.

Drug Interaction	Drug Names
Tetracyclines/Divalent & Trivalent Cations SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Di- and trivalent cations may form chelation complexes with tetracyclines, preventing their absorption.(1,2) CLINICAL EFFECTS: Simultaneous administration of di- or trivalent cations may result in decreased levels of and therapeutics effects from tetracyclines. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Administer tetracyclines at least two hours before or after the di- or trivalent cations. When used for the treatment of H. pylori infection, tetracyclines and bismuth should be given simultaneously. The US manufacturer of omadacycline states to fast for at least four hours, administer omadacycline, and then wait four hours before taking di- or trivalent cations.(21) DISCUSSION: Concurrent administration of aluminum hydroxide or divalent cations (such as calcium, magnesium, or zinc) has been shown to significantly decrease the gastrointestinal absorption of tetracycline.(3-5) Concurrent administration of tetracycline and magnesium-aluminum hydroxide gel has been shown to decrease the tetracycline area-under-curve (AUC) by 90%.(6) Magnesium-aluminum silicate has been shown to decrease the AUC of tetracycline by 27%.(7) Demeclocycline(8,9) methacycline,(10) chlortetracycline,(11) and oxytetracycline(10,12) have been shown to interact with aluminum hydroxide and/or dairy products. Doxycycline has been reported to interact with aluminum hydroxide gel.(13) Aluminum magnesium hydroxide has been shown to decrease doxycycline absorption by 84%.(14) Minocycline absorption has been shown to be impaired by aluminum, calcium, and magnesium.(15) Bismuth subsalicylate has been shown to decrease absorption of doxycycline and tetracycline by 37%(16) and 34%,(17) respectively. Since sucralfate is an aluminum salt of a sulfated disaccharide, it may also prevent absorption of tetracyclines. This complex has been used to provide site-specific delivery of tetracycline to gastric ulcers in the treatment of Helicobacter pylori gastric ulcer disease and may be useful in some indications.(18) Quinapril tablets contain a high percentage of magnesium and have been shown to decrease the absorption of tetracycline by 28-37%.(19) Lanthanum is expected to interact with tetracyclines as well.(20)	ACCRUFER, ALUMINUM HYDROXIDE, ATTAPULGITE, AUROVELA 24 FE, AUROVELA FE, AURYXIA, BALCOLTRA, BISMUTH CITRATE, BISMUTH SUBSALICYLATE, BLISOVI 24 FE, BLISOVI FE, CALCIUM ACETATE, CALCIUM CHLORIDE, CALCIUM GLUCONATE, CALCIUM GLUCONATE MONOHYDRATE, CARAFATE, CHARLOTTE 24 FE, CLENPIQ, FINZALA, FOSRENOL, GEMMILY, HAILEY 24 FE, HAILEY FE, JOYEAUX, JUNEL FE, JUNEL FE 24, KAITLIB FE, KAOLIN, LANTHANUM CARBONATE, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEVONORG-ETH ESTRAD-FE BISGLYC, LO LOESTRIN FE, LOESTRIN FE, MAGNESIUM CHLORIDE, MAGNESIUM CITRATE, MAGNESIUM OXIDE, MAGNESIUM SULFATE, MERZEE, MIBELAS 24 FE, MICROGESTIN 24 FE, MICROGESTIN FE, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRONE-E.ESTRADIOL-IRON, SOD SULF-POTASS SULF-MAG SULF, SUCRALFATE, SUFLAVE, SUPREP, SUTAB, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-LEGEST FE, VELPHORO, WYMZYA FE, ZINC CHLORIDE, ZINC OXIDE, ZINC SULFATE
Doxycycline/CYP3A4 Inducers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: CYP3A4 inducers may induce the metabolism of doxycyline. CLINICAL EFFECTS: Concurrent or recent use of an inducer of CYP3A4 may result in decreased antimicrobial activity of doxycycline. PREDISPOSING FACTORS: Induction effects may be more likely with regular use of the inducer for longer than 1-2 weeks. PATIENT MANAGEMENT: If both drugs are administered, monitor the response to doxycycline. Adjust the dose of the drug or consider administration of a non-interacting tetracycline analogue (e.g. tetracycline) if necessary. DISCUSSION: The effects of the interaction develop over approximately one to two weeks after starting the inducer and reverse over a period of several weeks after stopping the inducer. The elimination of demeclocycline, methacycline, oxytetracycline and tetracycline are not expected to be altered by CYP3A4 inducers as these tetracyclines are primarily excreted by the kidneys. Serum doxycycline concentrations may increase when the inducer is stopped. In a study, the half-life of doxycycline in 7 patients on long-term phenytoin therapy, 5 patients on long-term carbamazepine therapy, 4 patients on long-term combination phenytoin and carbamazepine therapy, and 9 control subjects was 7.2 hours, 8.4 hours, 7.4 hours, and 15.1 hours, respectively.(1) In a study, the half-life of doxycycline was significantly reduced in patients receiving barbiturate therapy.(2) In a study that compared healthy-controls with patients on long-term antiepileptic therapy, the half-life of doxycyline was significantly decreased in patients receiving barbiturates, phenytoin, or carbamazepine. The half-lives of chlortetracycline, demethylchlortetracycline, methacycline, oxytetracycline, and tetracycline were unaffected.(3) In a study in 7 patients, the half-life of doxycycline (200 mg/day) decreased from 17.9 hours to 9.2 hours following the addition of rifampin (10 mg/kg/day) to therapy.(4) CYP3A4 inducers linked to this monograph include: apalutamide, barbiturates, carbamazepine, encorafenib, enzalutamide, fosphenytoin, ivosidenib, lumacaftor, mitotane, phenytoin, primidone, rifamycins, and St. John's Wort.	ASA-BUTALB-CAFFEINE-CODEINE, ASCOMP WITH CODEINE, BRAFTOVI, BUTALB-ACETAMINOPH-CAFF-CODEIN, BUTALBITAL, BUTALBITAL-ACETAMINOPHEN, BUTALBITAL-ACETAMINOPHEN-CAFFE, BUTALBITAL-ASPIRIN-CAFFEINE, CARBAMAZEPINE, CARBAMAZEPINE ER, CARBATROL, CEREBYX, DILANTIN, DILANTIN-125, DONNATAL, EPITOL, EQUETRO, ERLEADA, ESGIC, FIORICET, FIORICET WITH CODEINE, FOSPHENYTOIN SODIUM, LYSODREN, MITOTANE, MYSOLINE, ORKAMBI, PENTOBARBITAL SODIUM, PHENOBARBITAL, PHENOBARBITAL SODIUM, PHENOBARBITAL-BELLADONNA, PHENOBARBITAL-HYOSC-ATROP-SCOP, PHENOHYTRO, PHENYTEK, PHENYTOIN, PHENYTOIN SODIUM, PHENYTOIN SODIUM EXTENDED, PRIFTIN, PRIMIDONE, RIFADIN, RIFAMPIN, SEZABY, TEGRETOL, TEGRETOL XR, TENCON, TIBSOVO, XTANDI
Contraceptives/Tetracyclines; Tigecycline SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Not established. CLINICAL EFFECTS: Reduced pharmacologic effects of oral contraceptives with resultant breakthrough bleeding and pregnancy may occur. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Current guidelines suggest that additional precautions are not necessary when non-enzyme inducing antibiotics are used concurrently with hormonal contraceptives; however, some patients may still prefer to use an additional method of contraception. DISCUSSION: Evidence for this interaction is limited and conflicting; however, the CDC and the Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit no longer recommend use of a backup contraceptive method during use of a non-enzyme inducing antibiotic. Pregnancy has been reported following the addition of tetracycline to oral contraceptive therapy.(1) In contrast, a study in 7 healthy women found no effect of tetracycline on ethinyl estradiol or norethindrone levels.(2) A study in 24 healthy women found no significant effects of doxycycline on ethinyl estradiol, norethindrone, or progesterone levels. However, the authors noted that there large inter-patient and inter-patient variability in these levels and that the interaction may just manifest itself in a small proportion of women.(3)	2-METHOXYESTRADIOL, AFIRMELLE, ALTAVERA, ALYACEN, AMETHIA, AMETHYST, APRI, ARANELLE, ASHLYNA, AUBRA, AUBRA EQ, AUROVELA, AUROVELA 24 FE, AUROVELA FE, AVIANE, AYUNA, AZURETTE, BALCOLTRA, BALZIVA, BEYAZ, BLISOVI 24 FE, BLISOVI FE, BRIELLYN, CAMILA, CAMRESE, CAMRESE LO, CAZIANT, CHARLOTTE 24 FE, CHATEAL, CHATEAL EQ, CRYSELLE, CYRED, CYRED EQ, DASETTA, DAYSEE, DEBLITANE, DESOGESTR-ETH ESTRAD ETH ESTRA, DIETHYLSTILBESTROL, DOLISHALE, DROSPIRENONE-ETH ESTRA-LEVOMEF, DROSPIRENONE-ETHINYL ESTRADIOL, ELINEST, ELLA, EMZAHH, ENPRESSE, ENSKYCE, ERRIN, ESTARYLLA, ESTRADIOL, ESTRADIOL BENZOATE, ESTRADIOL CYPIONATE, ESTRADIOL HEMIHYDRATE, ESTRADIOL HEMIHYDRATE MICRO, ESTRADIOL MICRONIZED, ESTRADIOL VALERATE, ESTRIOL, ESTRIOL MICRONIZED, ESTRONE, ETHINYL ESTRADIOL, ETHYNODIOL-ETHINYL ESTRADIOL, FALMINA, FEMLYV, FINZALA, GEMMILY, HAILEY, HAILEY 24 FE, HAILEY FE, HEATHER, ICLEVIA, INCASSIA, ISIBLOOM, JAIMIESS, JASMIEL, JENCYCLA, JOLESSA, JOYEAUX, JULEBER, JUNEL, JUNEL FE, JUNEL FE 24, KAITLIB FE, KALLIGA, KARIVA, KELNOR 1-35, KELNOR 1-50, KURVELO, LARIN, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEENA, LESSINA, LEVONEST, LEVONORG-ETH ESTRAD ETH ESTRAD, LEVONORG-ETH ESTRAD-FE BISGLYC, LEVONORGESTREL-ETH ESTRADIOL, LEVORA-28, LO LOESTRIN FE, LO-ZUMANDIMINE, LOESTRIN, LOESTRIN FE, LOJAIMIESS, LORYNA, LOW-OGESTREL, LUTERA, LYLEQ, LYZA, MARLISSA, MERZEE, MIBELAS 24 FE, MICROGESTIN, MICROGESTIN 24 FE, MICROGESTIN FE, MILI, MONO-LINYAH, NATAZIA, NECON, NEXTSTELLIS, NIKKI, NORA-BE, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRON-ETHINYL ESTRADIOL, NORETHINDRONE, NORETHINDRONE-E.ESTRADIOL-IRON, NORGESTIMATE-ETHINYL ESTRADIOL, NORTREL, NYLIA, NYMYO, OCELLA, ORTHO TRI-CYCLEN, ORTHO-NOVUM, PHILITH, PIMTREA, PORTIA, QUARTETTE, RECLIPSEN, RIVELSA, SAFYRAL, SETLAKIN, SHAROBEL, SIMLIYA, SIMPESSE, SLYND, SPRINTEC, SRONYX, SYEDA, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-ESTARYLLA, TRI-LEGEST FE, TRI-LINYAH, TRI-LO-ESTARYLLA, TRI-LO-MARZIA, TRI-LO-MILI, TRI-LO-SPRINTEC, TRI-MILI, TRI-NYMYO, TRI-SPRINTEC, TRI-VYLIBRA, TRI-VYLIBRA LO, TRIVORA-28, TULANA, TURQOZ, TYBLUME, TYDEMY, VELIVET, VESTURA, VIENVA, VIORELE, VOLNEA, VYFEMLA, VYLIBRA, WERA, WYMZYA FE, YASMIN 28, YAZ, ZARAH, ZOVIA 1-35, ZUMANDIMINE
Digoxin, Oral/Tetracyclines SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: In approximately 10% of patients receiving digoxin, a considerable amount of an administered dose of the drug is metabolized by GI bacteria to inactive digoxin reduction products (DRPs). Concomitant administration of tetracycline may alter the GI flora, enabling an increased amount of digoxin to be absorbed. CLINICAL EFFECTS: Increased serum digoxin levels with possible toxicity may occur. This effect may persist for several months after tetracycline is discontinued. Symptoms of digoxin toxicity can include anorexia, nausea, vomiting, headache, fatigue, malaise, drowsiness, generalized muscle weakness, disorientation, hallucinations, visual disturbances, and arrhythmias. PREDISPOSING FACTORS: Low body weight, advanced age, impaired renal function, hypokalemia, hypercalcemia, and/or hypomagnesemia may increase the risk of digoxin toxicity. PATIENT MANAGEMENT: Monitor serum digoxin levels and observe the patient for toxicity. The dosage of digoxin may need to be decreased by 30-50% or the frequency of administration may be reduced.(3) DISCUSSION: Approximately 10% of the patients receiving digoxin metabolize 30% or more of an ingested dose of digoxin to inactive DRPs. Concurrent current administration of tetracycline may alter the GI flora, decreasing the conversion of digoxin to DRPs. In these patients this could produce an increase in plasma digoxin concentration. The effect of tetracycline on the metabolism of digoxin to DRPs may persist for several months after the antibiotic is discontinued. Concomitant administration of tetracycline and digoxin increased the digoxin serum concentration 100%. (3)	DIGITEK, DIGOXIN, DIGOXIN MICRONIZED, LANOXIN
Coumarin Anticoagulants/Tetracyclines SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown. Tetracyclines may interfere with vitamin-K producing gut flora. CLINICAL EFFECTS: The addition of a tetracycline to a patient maintained on a coumarin anticoagulant may result in increased anticoagulant effects, including bleeding. PREDISPOSING FACTORS: he risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs). PATIENT MANAGEMENT: Patients maintained on coumarin anticoagulants should be closely monitored when tetracyclines are initiated and discontinued. The dosage of the anticoagulant may need to be adjusted. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug. DISCUSSION: In a retrospective review of patients receiving either acenocoumarol or phenprocoumon, use of doxycycline and tetracycline was associated with relative risk of major bleeding of 3 and 9, respectively.(1) There are several case reports of bleeding following the addition of doxycycline(2-4) and tetracycline(5,6) to warfarin therapy.	DICUMAROL, JANTOVEN, WARFARIN SODIUM

Severe List
Clostridioides difficile infection
Esophageal dysmotility
Intracranial hypertension
Myasthenia gravis
Pregnancy

The following adverse reaction information is available for MONODOX (doxycycline monohydrate):

Overview
Severe
Less Severe

Adverse reaction overview.

No enhanced Common Adverse Effects information available for this drug.

There are 27 severe adverse reactions.

More Frequent	Less Frequent
Dental discoloration	Hypertension Serum sickness Skin photosensitivity

Rare/Very Rare
Acute lupus erythematosus Anaphylaxis Angioedema Clostridioides difficile infection DRESS syndrome Erythema multiforme Esophageal ulcer Exfoliative dermatitis Fungal infection Hemolytic anemia Hepatitis Hypersensitivity drug reaction Idiopathic intracranial hypertension Intracranial hypertension Maculopapular rash Neutropenic disorder Pancreatitis Pericarditis Purpura Stevens-johnson syndrome Thrombocytopenic disorder Toxic epidermal necrolysis Urticaria

Rare/Very Rare

Acute lupus erythematosus
Anaphylaxis
Angioedema
Clostridioides difficile infection
DRESS syndrome
Erythema multiforme
Esophageal ulcer
Exfoliative dermatitis
Fungal infection
Hemolytic anemia
Hepatitis
Hypersensitivity drug reaction
Idiopathic intracranial hypertension
Intracranial hypertension
Maculopapular rash
Neutropenic disorder
Pancreatitis
Pericarditis
Purpura
Stevens-johnson syndrome
Thrombocytopenic disorder
Toxic epidermal necrolysis
Urticaria

There are 19 less severe adverse reactions.

More Frequent	Less Frequent
Nausea Vomiting	Anorexia Diarrhea Headache disorder Pharyngitis Upper abdominal pain Vaginitis Vulvovaginal candidiasis

Rare/Very Rare
Anogenital candidiasis Dysphagia Enterocolitis Eosinophilia Erythema Esophagitis Glossitis Jarisch-herxheimer reaction Skin pigmentation enhancement Skin rash

The following precautions are available for MONODOX (doxycycline monohydrate):

Pediatric
Pregnant
Lactation
Geriatric

No enhanced Pediatric Use information available for this drug.

Contraindicated

None

Severe Precaution

Doxycycline

1 Day – 8 Years

Permanent tooth discoloration and/or enamel hypoplasia may occur. Slowed growth possible secondary to calcium complex in bone tissue. Weigh risk-benefit. Limit duration of use.

Management or Monitoring Precaution

None

No enhanced Pregnancy information available for this drug.

Drug/Drug Class	Severity	Precaution Description	Pregnancy Category Description
Doxycycline	D	Infant skeletal abnormalities&Permanent tooth discoloring possib in 2Nd/3Rd trim	Positive evidence of human fetal risk based on investigation or marketing information but potential benefits may warrant use of drug in pregnant women despite potential risks.

No enhanced Lactation information available for this drug.

Precaution Exists
Precaution exists. (No data or inconclusive human data.) Use of this drug by breast feeding mothers should be evaluated carefully.

Drug Name	Excretion Potential	Effect on Infant	Notes
Doxycycline	Excreted.This drug is known to be excreted in human breast milk.	This drug has been shown to have an adverse effect on the nursing infant.	Dental stains & bone growth inhibition may occur w/ extended use

No enhanced Geriatric Use information available for this drug.

The following icd codes are available for MONODOX (doxycycline monohydrate)'s list of indications:

Acne vulgaris
L70.0	Acne vulgaris
Actinomycosis
A42	Actinomycosis
A42.0	Pulmonary actinomycosis
A42.1	Abdominal actinomycosis
A42.2	Cervicofacial actinomycosis
A42.7	Actinomycotic sepsis
A42.8	Other forms of actinomycosis
A42.81	Actinomycotic meningitis
A42.82	Actinomycotic encephalitis
A42.89	Other forms of actinomycosis
A42.9	Actinomycosis, unspecified
Acute gonococcal cervicitis
A54.03	Gonococcal cervicitis, unspecified
Acute gonococcal endometritis
A54.24	Gonococcal female pelvic inflammatory disease
Acute gonococcal epididymo-orchitis
A54.23	Gonococcal infection of other male genital organs
Acute gonococcal urethritis
A54.00	Gonococcal infection of lower genitourinary tract, unspecified
A54.01	Gonococcal cystitis and urethritis, unspecified
Acute lower genitourinary gonorrhea
A54.0	Gonococcal infection of lower genitourinary tract without periurethral or accessory gland abscess
A54.00	Gonococcal infection of lower genitourinary tract, unspecified
A54.01	Gonococcal cystitis and urethritis, unspecified
A54.02	Gonococcal vulvovaginitis, unspecified
A54.03	Gonococcal cervicitis, unspecified
A54.09	Other gonococcal infection of lower genitourinary tract
A54.1	Gonococcal infection of lower genitourinary tract with periurethral and accessory gland abscess
Acute staph. aureus sinusitis
B95.6	Staphylococcus aureus as the cause of diseases classified elsewhere
B95.61	Methicillin susceptible staphylococcus aureus infection as the cause of diseases classified elsewhere
B95.62	Methicillin resistant staphylococcus aureus infection as the cause of diseases classified elsewhere
J01	Acute sinusitis
J01.0	Acute maxillary sinusitis
J01.00	Acute maxillary sinusitis, unspecified
J01.01	Acute recurrent maxillary sinusitis
J01.1	Acute frontal sinusitis
J01.10	Acute frontal sinusitis, unspecified
J01.11	Acute recurrent frontal sinusitis
J01.2	Acute ethmoidal sinusitis
J01.20	Acute ethmoidal sinusitis, unspecified
J01.21	Acute recurrent ethmoidal sinusitis
J01.3	Acute sphenoidal sinusitis
J01.30	Acute sphenoidal sinusitis, unspecified
J01.31	Acute recurrent sphenoidal sinusitis
J01.4	Acute pansinusitis
J01.40	Acute pansinusitis, unspecified
J01.41	Acute recurrent pansinusitis
J01.8	Other acute sinusitis
J01.80	Other acute sinusitis
J01.81	Other acute recurrent sinusitis
J01.9	Acute sinusitis, unspecified
J01.90	Acute sinusitis, unspecified
J01.91	Acute recurrent sinusitis, unspecified
Bacterial pneumonia
J15.9	Unspecified bacterial pneumonia
Bacterial urinary tract infection
N30.0	Acute cystitis
N30.00	Acute cystitis without hematuria
N30.01	Acute cystitis with hematuria
N30.9	Cystitis, unspecified
N30.90	Cystitis, unspecified without hematuria
N30.91	Cystitis, unspecified with hematuria
N39.0	Urinary tract infection, site not specified
O23.0	Infections of kidney in pregnancy
O23.00	Infections of kidney in pregnancy, unspecified trimester
O23.01	Infections of kidney in pregnancy, first trimester
O23.02	Infections of kidney in pregnancy, second trimester
O23.03	Infections of kidney in pregnancy, third trimester
O23.1	Infections of bladder in pregnancy
O23.10	Infections of bladder in pregnancy, unspecified trimester
O23.11	Infections of bladder in pregnancy, first trimester
O23.12	Infections of bladder in pregnancy, second trimester
O23.13	Infections of bladder in pregnancy, third trimester
O23.2	Infections of urethra in pregnancy
O23.20	Infections of urethra in pregnancy, unspecified trimester
O23.21	Infections of urethra in pregnancy, first trimester
O23.22	Infections of urethra in pregnancy, second trimester
O23.23	Infections of urethra in pregnancy, third trimester
O23.3	Infections of other parts of urinary tract in pregnancy
O23.30	Infections of other parts of urinary tract in pregnancy, unspecified trimester
O23.31	Infections of other parts of urinary tract in pregnancy, first trimester
O23.32	Infections of other parts of urinary tract in pregnancy, second trimester
O23.33	Infections of other parts of urinary tract in pregnancy, third trimester
O23.4	Unspecified infection of urinary tract in pregnancy
O23.40	Unspecified infection of urinary tract in pregnancy, unspecified trimester
O23.41	Unspecified infection of urinary tract in pregnancy, first trimester
O23.42	Unspecified infection of urinary tract in pregnancy, second trimester
O23.43	Unspecified infection of urinary tract in pregnancy, third trimester
O23.90	Unspecified genitourinary tract infection in pregnancy, unspecified trimester
O23.91	Unspecified genitourinary tract infection in pregnancy, first trimester
O23.92	Unspecified genitourinary tract infection in pregnancy, second trimester
O23.93	Unspecified genitourinary tract infection in pregnancy, third trimester
P39.3	Neonatal urinary tract infection
T83	Complications of genitourinary prosthetic devices, implants and grafts
T83.5	Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system
T83.51	Infection and inflammatory reaction due to urinary catheter
T83.59	Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system
T83.6	Infection and inflammatory reaction due to prosthetic device, implant and graft in genital tract
Bartonellosis
A44	Bartonellosis
A44.0	Systemic bartonellosis
A44.1	Cutaneous and mucocutaneous bartonellosis
A44.8	Other forms of bartonellosis
A44.9	Bartonellosis, unspecified
Boutonneuse fever
A77.1	Spotted fever due to rickettsia conorii
Brucellosis
A23	Brucellosis
A23.0	Brucellosis due to brucella melitensis
A23.1	Brucellosis due to brucella abortus
A23.2	Brucellosis due to brucella suis
A23.3	Brucellosis due to brucella canis
A23.8	Other brucellosis
A23.9	Brucellosis, unspecified
Campylobacter fetus infection
B96.89	Other specified bacterial agents as the cause of diseases classified elsewhere
Chancroid
A57	Chancroid
Chlamydial infections
A55	Chlamydial lymphogranuloma (venereum)
A56	Other sexually transmitted chlamydial diseases
A56.0	Chlamydial infection of lower genitourinary tract
A56.00	Chlamydial infection of lower genitourinary tract, unspecified
A56.01	Chlamydial cystitis and urethritis
A56.02	Chlamydial vulvovaginitis
A56.09	Other chlamydial infection of lower genitourinary tract
A56.1	Chlamydial infection of pelviperitoneum and other genitourinary organs
A56.11	Chlamydial female pelvic inflammatory disease
A56.19	Other chlamydial genitourinary infection
A56.2	Chlamydial infection of genitourinary tract, unspecified
A56.3	Chlamydial infection of anus and rectum
A56.4	Chlamydial infection of pharynx
A56.8	Sexually transmitted chlamydial infection of other sites
A70	Chlamydia psittaci infections
A71	Trachoma
A71.0	Initial stage of trachoma
A71.1	Active stage of trachoma
A71.9	Trachoma, unspecified
A74	Other diseases caused by chlamydiae
A74.0	Chlamydial conjunctivitis
A74.8	Other chlamydial diseases
A74.81	Chlamydial peritonitis
A74.9	Chlamydial infection, unspecified
J16.0	Chlamydial pneumonia
P23.1	Congenital pneumonia due to chlamydia
Cholera
A00	Cholera
A00.0	Cholera due to vibrio cholerae 01, biovar cholerae
A00.1	Cholera due to vibrio cholerae 01, biovar eltor
A00.9	Cholera, unspecified
Cutaneous anthrax
A22.0	Cutaneous anthrax
Disseminated gonococcal infection
A54.8	Other gonococcal infections
A54.81	Gonococcal meningitis
A54.82	Gonococcal brain abscess
A54.83	Gonococcal heart infection
A54.84	Gonococcal pneumonia
A54.85	Gonococcal peritonitis
A54.86	Gonococcal sepsis
A54.89	Other gonococcal infections
Gastrointestinal anthrax
A22.2	Gastrointestinal anthrax
Genitourinary chlamydia trachomatis infection
A56.0	Chlamydial infection of lower genitourinary tract
A56.00	Chlamydial infection of lower genitourinary tract, unspecified
A56.01	Chlamydial cystitis and urethritis
A56.02	Chlamydial vulvovaginitis
A56.09	Other chlamydial infection of lower genitourinary tract
A56.1	Chlamydial infection of pelviperitoneum and other genitourinary organs
A56.11	Chlamydial female pelvic inflammatory disease
A56.19	Other chlamydial genitourinary infection
A56.2	Chlamydial infection of genitourinary tract, unspecified
Gonococcal pharyngitis
A54.5	Gonococcal pharyngitis
Granuloma inguinale
A58	Granuloma inguinale
Inclusion conjunctivitis caused by chlamydia trachomatis
A74.0	Chlamydial conjunctivitis
Inhaled anthrax
A22.1	Pulmonary anthrax
Listeriosis
A32	Listeriosis
A32.0	Cutaneous listeriosis
A32.1	Listerial meningitis and meningoencephalitis
A32.11	Listerial meningitis
A32.12	Listerial meningoencephalitis
A32.7	Listerial sepsis
A32.8	Other forms of listeriosis
A32.81	Oculoglandular listeriosis
A32.82	Listerial endocarditis
A32.89	Other forms of listeriosis
A32.9	Listeriosis, unspecified
P37.2	Neonatal (disseminated) listeriosis
Louse-borne typhus
A75.0	Epidemic louse-borne typhus fever due to rickettsia prowazekii
Lymphogranuloma venereum
A55	Chlamydial lymphogranuloma (venereum)
Murine typhus
A75.2	Typhus fever due to rickettsia typhi
A75.9	Typhus fever, unspecified
Mycoplasmal pneumonia
J15.7	Pneumonia due to mycoplasma pneumoniae
Nongonococcal urethritis
A56.01	Chlamydial cystitis and urethritis
N34.1	Nonspecific urethritis
Pharyngitis
J02	Acute pharyngitis
J02.0	Streptococcal pharyngitis
J02.8	Acute pharyngitis due to other specified organisms
J02.9	Acute pharyngitis, unspecified
Plague
A20	Plague
A20.0	Bubonic plague
A20.1	Cellulocutaneous plague
A20.2	Pneumonic plague
A20.3	Plague meningitis
A20.7	Septicemic plague
A20.8	Other forms of plague
A20.9	Plague, unspecified
Post-exposure anthrax prevention
Z20.810	Contact with and (suspected) exposure to anthrax
Psittacosis
A70	Chlamydia psittaci infections
Q fever
A78	Q fever
Q fever endocarditis
A78	Q fever
Recrudescent typhus
A75.1	Recrudescent typhus [brill's disease]
Rectal chlamydia trachomatis infection
A56.3	Chlamydial infection of anus and rectum
Rectal gonorrhea
A54.6	Gonococcal infection of anus and rectum
Relapsing fever
A68	Relapsing fevers
A68.0	Louse-borne relapsing fever
A68.9	Relapsing fever, unspecified
Rickettsial infection
A75	Typhus fever
A75.0	Epidemic louse-borne typhus fever due to rickettsia prowazekii
A75.1	Recrudescent typhus [brill's disease]
A75.2	Typhus fever due to rickettsia typhi
A75.3	Typhus fever due to rickettsia tsutsugamushi
A75.9	Typhus fever, unspecified
A77	Spotted fever [tick-borne rickettsioses]
A77.0	Spotted fever due to rickettsia rickettsii
A77.1	Spotted fever due to rickettsia conorii
A77.2	Spotted fever due to rickettsia siberica
A77.3	Spotted fever due to rickettsia australis
A77.8	Other spotted fevers
A77.9	Spotted fever, unspecified
A79	Other rickettsioses
A79.0	Trench fever
A79.1	Rickettsialpox due to rickettsia akari
A79.8	Other specified rickettsioses
A79.81	Rickettsiosis due to ehrlichia sennetsu
A79.82	Anaplasmosis [a. phagocytophilum]
A79.89	Other specified rickettsioses
A79.9	Rickettsiosis, unspecified
Rickettsialpox
A79.1	Rickettsialpox due to rickettsia akari
Rocky mountain spotted fever
A77.0	Spotted fever due to rickettsia rickettsii
Scrub typhus
A75.3	Typhus fever due to rickettsia tsutsugamushi
Sinusitis
J01	Acute sinusitis
J01.0	Acute maxillary sinusitis
J01.00	Acute maxillary sinusitis, unspecified
J01.01	Acute recurrent maxillary sinusitis
J01.1	Acute frontal sinusitis
J01.10	Acute frontal sinusitis, unspecified
J01.11	Acute recurrent frontal sinusitis
J01.2	Acute ethmoidal sinusitis
J01.20	Acute ethmoidal sinusitis, unspecified
J01.21	Acute recurrent ethmoidal sinusitis
J01.3	Acute sphenoidal sinusitis
J01.30	Acute sphenoidal sinusitis, unspecified
J01.31	Acute recurrent sphenoidal sinusitis
J01.4	Acute pansinusitis
J01.40	Acute pansinusitis, unspecified
J01.41	Acute recurrent pansinusitis
J01.8	Other acute sinusitis
J01.80	Other acute sinusitis
J01.81	Other acute recurrent sinusitis
J01.9	Acute sinusitis, unspecified
J01.90	Acute sinusitis, unspecified
J01.91	Acute recurrent sinusitis, unspecified
J32	Chronic sinusitis
J32.0	Chronic maxillary sinusitis
J32.1	Chronic frontal sinusitis
J32.2	Chronic ethmoidal sinusitis
J32.3	Chronic sphenoidal sinusitis
J32.4	Chronic pansinusitis
J32.8	Other chronic sinusitis
J32.9	Chronic sinusitis, unspecified
Skin and skin structure infection
H05.01	Cellulitis of orbit
H05.011	Cellulitis of right orbit
H05.012	Cellulitis of left orbit
H05.013	Cellulitis of bilateral orbits
H05.019	Cellulitis of unspecified orbit
H60.1	Cellulitis of external ear
H60.10	Cellulitis of external ear, unspecified ear
H60.11	Cellulitis of right external ear
H60.12	Cellulitis of left external ear
H60.13	Cellulitis of external ear, bilateral
K12.2	Cellulitis and abscess of mouth
L03	Cellulitis and acute lymphangitis
L03.0	Cellulitis and acute lymphangitis of finger and toe
L03.01	Cellulitis of finger
L03.011	Cellulitis of right finger
L03.012	Cellulitis of left finger
L03.019	Cellulitis of unspecified finger
L03.03	Cellulitis of toe
L03.031	Cellulitis of right toe
L03.032	Cellulitis of left toe
L03.039	Cellulitis of unspecified toe
L03.1	Cellulitis and acute lymphangitis of other parts of limb
L03.11	Cellulitis of other parts of limb
L03.111	Cellulitis of right axilla
L03.112	Cellulitis of left axilla
L03.113	Cellulitis of right upper limb
L03.114	Cellulitis of left upper limb
L03.115	Cellulitis of right lower limb
L03.116	Cellulitis of left lower limb
L03.119	Cellulitis of unspecified part of limb
L03.2	Cellulitis and acute lymphangitis of face and neck
L03.21	Cellulitis and acute lymphangitis of face
L03.211	Cellulitis of face
L03.22	Cellulitis and acute lymphangitis of neck
L03.221	Cellulitis of neck
L03.3	Cellulitis and acute lymphangitis of trunk
L03.31	Cellulitis of trunk
L03.311	Cellulitis of abdominal wall
L03.312	Cellulitis of back [any part except buttock]
L03.313	Cellulitis of chest wall
L03.314	Cellulitis of groin
L03.315	Cellulitis of perineum
L03.316	Cellulitis of umbilicus
L03.317	Cellulitis of buttock
L03.319	Cellulitis of trunk, unspecified
L03.8	Cellulitis and acute lymphangitis of other sites
L03.81	Cellulitis of other sites
L03.811	Cellulitis of head [any part, except face]
L03.818	Cellulitis of other sites
L03.9	Cellulitis and acute lymphangitis, unspecified
L03.90	Cellulitis, unspecified
L08.9	Local infection of the skin and subcutaneous tissue, unspecified
N48.22	Cellulitis of corpus cavernosum and penis
Syphilis
A50	Congenital syphilis
A50.0	Early congenital syphilis, symptomatic
A50.01	Early congenital syphilitic oculopathy
A50.02	Early congenital syphilitic osteochondropathy
A50.03	Early congenital syphilitic pharyngitis
A50.04	Early congenital syphilitic pneumonia
A50.05	Early congenital syphilitic rhinitis
A50.06	Early cutaneous congenital syphilis
A50.07	Early mucocutaneous congenital syphilis
A50.08	Early visceral congenital syphilis
A50.09	Other early congenital syphilis, symptomatic
A50.1	Early congenital syphilis, latent
A50.2	Early congenital syphilis, unspecified
A50.3	Late congenital syphilitic oculopathy
A50.30	Late congenital syphilitic oculopathy, unspecified
A50.31	Late congenital syphilitic interstitial keratitis
A50.32	Late congenital syphilitic chorioretinitis
A50.39	Other late congenital syphilitic oculopathy
A50.4	Late congenital neurosyphilis [juvenile neurosyphilis]
A50.40	Late congenital neurosyphilis, unspecified
A50.41	Late congenital syphilitic meningitis
A50.42	Late congenital syphilitic encephalitis
A50.43	Late congenital syphilitic polyneuropathy
A50.44	Late congenital syphilitic optic nerve atrophy
A50.45	Juvenile general paresis
A50.49	Other late congenital neurosyphilis
A50.5	Other late congenital syphilis, symptomatic
A50.51	Clutton's joints
A50.52	Hutchinson's teeth
A50.53	Hutchinson's triad
A50.54	Late congenital cardiovascular syphilis
A50.55	Late congenital syphilitic arthropathy
A50.56	Late congenital syphilitic osteochondropathy
A50.57	Syphilitic saddle nose
A50.59	Other late congenital syphilis, symptomatic
A50.6	Late congenital syphilis, latent
A50.7	Late congenital syphilis, unspecified
A50.9	Congenital syphilis, unspecified
A51	Early syphilis
A51.0	Primary genital syphilis
A51.1	Primary anal syphilis
A51.2	Primary syphilis of other sites
A51.3	Secondary syphilis of skin and mucous membranes
A51.31	Condyloma latum
A51.32	Syphilitic alopecia
A51.39	Other secondary syphilis of skin
A51.4	Other secondary syphilis
A51.41	Secondary syphilitic meningitis
A51.42	Secondary syphilitic female pelvic disease
A51.43	Secondary syphilitic oculopathy
A51.44	Secondary syphilitic nephritis
A51.45	Secondary syphilitic hepatitis
A51.46	Secondary syphilitic osteopathy
A51.49	Other secondary syphilitic conditions
A51.5	Early syphilis, latent
A51.9	Early syphilis, unspecified
A52	Late syphilis
A52.0	Cardiovascular and cerebrovascular syphilis
A52.00	Cardiovascular syphilis, unspecified
A52.01	Syphilitic aneurysm of aorta
A52.02	Syphilitic aortitis
A52.03	Syphilitic endocarditis
A52.04	Syphilitic cerebral arteritis
A52.05	Other cerebrovascular syphilis
A52.06	Other syphilitic heart involvement
A52.09	Other cardiovascular syphilis
A52.1	Symptomatic neurosyphilis
A52.10	Symptomatic neurosyphilis, unspecified
A52.11	Tabes dorsalis
A52.12	Other cerebrospinal syphilis
A52.13	Late syphilitic meningitis
A52.14	Late syphilitic encephalitis
A52.15	Late syphilitic neuropathy
A52.16	Charcot's arthropathy (tabetic)
A52.17	General paresis
A52.19	Other symptomatic neurosyphilis
A52.2	Asymptomatic neurosyphilis
A52.3	Neurosyphilis, unspecified
A52.7	Other symptomatic late syphilis
A52.71	Late syphilitic oculopathy
A52.72	Syphilis of lung and bronchus
A52.73	Symptomatic late syphilis of other respiratory organs
A52.74	Syphilis of liver and other viscera
A52.75	Syphilis of kidney and ureter
A52.76	Other genitourinary symptomatic late syphilis
A52.77	Syphilis of bone and joint
A52.78	Syphilis of other musculoskeletal tissue
A52.79	Other symptomatic late syphilis
A52.8	Late syphilis, latent
A52.9	Late syphilis, unspecified
A53	Other and unspecified syphilis
A53.0	Latent syphilis, unspecified as early or late
A53.9	Syphilis, unspecified
A65	Nonvenereal syphilis
O98.1	Syphilis complicating pregnancy, childbirth and the puerperium
O98.11	Syphilis complicating pregnancy
O98.111	Syphilis complicating pregnancy, first trimester
O98.112	Syphilis complicating pregnancy, second trimester
O98.113	Syphilis complicating pregnancy, third trimester
O98.119	Syphilis complicating pregnancy, unspecified trimester
O98.12	Syphilis complicating childbirth
O98.13	Syphilis complicating the puerperium
Trachoma
A71	Trachoma
A71.0	Initial stage of trachoma
A71.1	Active stage of trachoma
A71.9	Trachoma, unspecified
Tularemia
A21	Tularemia
A21.0	Ulceroglandular tularemia
A21.1	Oculoglandular tularemia
A21.2	Pulmonary tularemia
A21.3	Gastrointestinal tularemia
A21.7	Generalized tularemia
A21.8	Other forms of tularemia
A21.9	Tularemia, unspecified
Typhus infections
A75	Typhus fever
A75.0	Epidemic louse-borne typhus fever due to rickettsia prowazekii
A75.1	Recrudescent typhus [brill's disease]
A75.2	Typhus fever due to rickettsia typhi
A75.3	Typhus fever due to rickettsia tsutsugamushi
A75.9	Typhus fever, unspecified
Upper respiratory infection from haemophilus influenzae
J06.9	Acute upper respiratory infection, unspecified
Upper respiratory pneumococcal infection
B95.3	Streptococcus pneumoniae as the cause of diseases classified elsewhere
J00	Acute nasopharyngitis [common cold]
J01	Acute sinusitis
J01.0	Acute maxillary sinusitis
J01.00	Acute maxillary sinusitis, unspecified
J01.01	Acute recurrent maxillary sinusitis
J01.1	Acute frontal sinusitis
J01.10	Acute frontal sinusitis, unspecified
J01.11	Acute recurrent frontal sinusitis
J01.2	Acute ethmoidal sinusitis
J01.20	Acute ethmoidal sinusitis, unspecified
J01.21	Acute recurrent ethmoidal sinusitis
J01.3	Acute sphenoidal sinusitis
J01.30	Acute sphenoidal sinusitis, unspecified
J01.31	Acute recurrent sphenoidal sinusitis
J01.4	Acute pansinusitis
J01.40	Acute pansinusitis, unspecified
J01.41	Acute recurrent pansinusitis
J01.8	Other acute sinusitis
J01.80	Other acute sinusitis
J01.81	Other acute recurrent sinusitis
J01.9	Acute sinusitis, unspecified
J01.90	Acute sinusitis, unspecified
J01.91	Acute recurrent sinusitis, unspecified
J02	Acute pharyngitis
J02.0	Streptococcal pharyngitis
J02.9	Acute pharyngitis, unspecified
J03	Acute tonsillitis
J03.0	Streptococcal tonsillitis
J03.00	Acute streptococcal tonsillitis, unspecified
J03.01	Acute recurrent streptococcal tonsillitis
J03.9	Acute tonsillitis, unspecified
J03.90	Acute tonsillitis, unspecified
J03.91	Acute recurrent tonsillitis, unspecified
J04	Acute laryngitis and tracheitis
J04.0	Acute laryngitis
J04.1	Acute tracheitis
J04.10	Acute tracheitis without obstruction
J04.11	Acute tracheitis with obstruction
J04.2	Acute laryngotracheitis
J04.3	Supraglottitis, unspecified
J04.30	Supraglottitis, unspecified, without obstruction
J04.31	Supraglottitis, unspecified, with obstruction
J05	Acute obstructive laryngitis [croup] and epiglottitis
J05.0	Acute obstructive laryngitis [croup]
J05.1	Acute epiglottitis
J05.10	Acute epiglottitis without obstruction
J05.11	Acute epiglottitis with obstruction
J06	Acute upper respiratory infections of multiple and unspecified sites
J06.0	Acute laryngopharyngitis
J06.9	Acute upper respiratory infection, unspecified
Yaws
A66	Yaws
A66.0	Initial lesions of yaws
A66.1	Multiple papillomata and wet crab yaws
A66.2	Other early skin lesions of yaws
A66.3	Hyperkeratosis of yaws
A66.4	Gummata and ulcers of yaws
A66.5	Gangosa
A66.6	Bone and joint lesions of yaws
A66.7	Other manifestations of yaws
A66.8	Latent yaws
A66.9	Yaws, unspecified