ICMR Releases Antimicrobial Guidelines 2022: Update on Doxycycline

The Indian Council of Medical Research (ICMR), one of the oldest medical research bodies in the world, has recently released a revised, updated version of guidelines for antimicrobial treatment in India in the year 2022. The goal of the guideline is to provide medical personnel with a practical guide for treating patients and using antimicrobial agents appropriately.

These 2022 ICMR Guidelines focus on the antibiotic use in common ailments and infections such as acute fever, sepsis, respiratory tract infections, urinary tract infections, central nervous system infections, skin and soft tissue infections, etc. The guidelines recommend the use of doxycycline in various disease conditions. The recommendations on the use of doxycycline are given below.

Acute undifferentiated fever

Empirical treatment with doxycycline for patients with undifferentiated fever and negative rapid diagnostic tests for malaria and dengue is an option for the clinician.

Short-term prophylaxis of malaria

Doxycycline 100 mg daily in adults and 1.5 mg/kg for children more than 8 years old can be given for short-term prophylaxis of malaria. The drug should be started 2 days before travel and continued for 4 weeks after leaving the malarious area.

Rickettsial infections and leptospirosis

• Doxycycline is the preferred treatment for rickettsial infections for a duration of 7 days.

• It is also used as a treatment for leptospirosis, for a period of 7 days.

Skin and soft-tissue infections (SSTIs)

Doxycycline, in combination with ciprofloxacin, is the preferred antibiotic for the treatment of necrotizing fasciitis occurred by Aeromonas/V. vulnificus.

Acute febrile encephalopathy (AFE)/ acute encephalitis syndrome (AES)

Initial management includes resuscitation and stabilization based on the clinical condition, followed by clinical evaluation, imaging, and investigations to establish the diagnosis. Empiric therapy (may include ceftriaxone, acyclovir, doxycycline, and artesunate) should be started immediately after drawing blood cultures, pending the results of tests. Supportive care should be continued, and then therapy should be narrowed based on the results of investigations.

Community-acquired pneumonia (CAP)

Doxycycline is the choice of empiric antimicrobial therapy in adult

CAP. It is the preferred drug for:

• Outpatients with co-morbidities* or use of antimicrobial in 3 months

• Inpatient, non-ICU

• Inpatient ICU

• Inpatient ICU with risk factors for Pseudomonas aeruginosa/other enteric gram-negative bacteria.

Urinary tract infections (when culture results are awaited) Doxycycline is a drug of choice for the treatment of epididymo- orchitis (high risk of being sexually transmitted) in combination with ceftriaxone.

Obstetrics and gynecology

Doxycycline in combination with other antimicrobial agents (AMAs) is preferred for the treatment of:

• Hysterosalpingography (HSG)

• Pelvic inflammatory disease (mild to moderate)

• Pelvic inflammatory disease (severe) e.g., turbo-ovarian abscess, pelvic abscess

Diarrhea

Doxycycline is used to treat diarrhea [300mg (not recommended in children and pregnant women)] for treating V. cholerae.

REFERENCE:

• Treatment guidelines for antimicrobial use in common syndromes 2022. ICMR guidelines.