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Is Doxycycline Safe in Children?

July 4, 2023

Written by Clay Smith

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There is no association of doxycycline and tooth staining in children under 8 when used at usual dose and duration.

This study has teeth
Antibiotic exposure before age 8 could impact developing tooth enamel or could accelerate dental caries. Specifically, tetracycline can cause tooth staining. However, doxycycline is essential for tickborne illness in any age patient, but it is unclear whether it causes tooth staining. This systematic review of 34 retrospective studies found no association of antibiotic exposure in children under 8 years with enamel hypoplasia or dental caries and also did not find any association of doxycycline with tooth staining. 18 studies considered tetracycline or derivatives; 5 specifically covered doxycycline, largely in the usual dose range of 2.3 to 6.25 mg/kg per day, though one study use 25mg/kg. For example, 2.2mg/kg/dose, max 100mg, Q12h is usual dose for rickettsial disease. Higher doses of tetracycline >20mg/kg/day, in studies from the 1960s-1980s, were associated with staining. The 3 studies of doxycycline at the lowest risk of bias also showed no association with staining.

How will this change my practice?
I have always warned parents of children under age 8, who must receive doxycycline for presumed tickborne illness, that there is potential risk of tooth staining. Now, I will proactively reassure them there is no evidence for tooth staining in children under 8 who use doxycycline at usual doses for <21 days – which is also exactly what the Red Book says.

Antibiotic Exposure and Dental Health: A Systematic Review. Pediatrics. 2023 Jun 2;e2023061350. doi: 10.1542/peds.2023-061350. Online ahead of print.

What are your thoughts?