Doxycycline: Administration & Nursing Implications

Instructor: Charity Hacker

I am a nursing instructor with over 20 years of nursing experience and a Masters Degree in Nursing Education.

Anti-infectives are a broad class of drugs that act on infections by either stopping or killing an infectious agent. There are several groups of medications in this class that all act differently. In this lesson, we will learn about doxycycline as an anti-infective and all the things a nurse needs to know about it.

Let's meet Doxycycline

You know how every big family is full of different characters with different abilities? That's kind of how the family of anti-infectives is. In this big family, there are several different subclasses including the tetracyclines. Doxycycline is part of the tetracycline family that does all the odd things the other members can't do. Like what, you ask? It's a random one, treating things ranging from acne to anthrax. It focuses on organisms such as rickettsia, chlamydia, borellia burgdorferi, and mycoplasma.

Imagine you are the nurse for Mrs. Smith, who is having a recurrence of chronic bronchitis. She was prescribed doxycycline because her sputum culture showed susceptibility. What do you as a nurse need to know about it prior to administration?

Administration of Doxycycline

When to Administer Doxycycline

As a general rule, doxycycline is not administered with meals. You should administer it at least one hour before your patient eats or two hours after. Only if it causes stomach problems can it be given with food or milk. Regarding timeliness, it also should not be given at the same time as other medications, separate it by at least one hour. Specifically, it is very important to avoid calcium, antacids, iron, or medications containing magnesium. Lastly, it should not be given within an hour of laying down or sleeping. Doxycycline is given every 12 hours which can make these restrictions challenging. Lucky for you Mrs. Smith is an early riser and doesn't take very many other medications, so you can give it to her at 5 a.m. and 5 p.m., which is about an hour before both breakfast and dinner.

How to Administer Doxycycline

Doxycycline should be given with at least eight ounces of fluid because it has the potential to cause erosion of the esophagus. Also, if the patient has difficulty swallowing it, capsules may be opened and administered with applesauce. However, there are very specific instructions for giving doxycycline in applesauce and the nurse should review these prior to administering it this way. Extended release forms of doxycycline should not be broken, chewed, or split. It can be given in liquid form, however, the medication must be well shaken and measured meticulously if given this way. Just as there are very specific instructions regarding doxycycline administration with applesauce, there are also very specific instructions regarding its administration to youth in the case of a public emergency anthrax exposure. Your patient, Mrs. Smith, doesn't have any trouble swallowing but she doesn't feel well and isn't taking in enough fluids. It is really important that you stay with her long enough to ensure she drinks the full glass of fluids.

Nursing Implications

What is a nursing implication? It is something a nurse is responsible for knowing or doing. When it comes to medication administration, the nurse is responsible for assessment, monitoring, safety and patient teaching. Let's explore further:

You should ensure Mrs. Smith has had a culture and susceptibility prior to giving the first dose. During the therapy, you should monitor for signs or symptoms of infection, gastrointestinal upset, or skin changes, including rash. In the case of skin changes, therapy should be ended if any signs of flu occur with it. You, as the nurse, should take the time to teach Mrs. Smith what gastrointestinal symptoms to watch for and report; these may occur weeks after the patient leaves the hospital. If Mrs. Smith is receiving doxycycline through an intravenous site, it should be checked frequently for patency and signs or symptoms of infection.

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