Oral-Antral Fistula |
First Line |
Second Line |
Allergy status
(Confirm allergy status prior to choosing antimicrobial regime) |
No penicillin allergy |
|
Antimicrobial
Check for interactions |
Amoxicillin |
Doxycycline |
Dose |
500mg every 8 hours |
200mg stat, then 100mg every 12 hours |
Route |
PO |
PO |
Duration |
5 days |
Doxycycline is ineffective if given with multi-valent cation containing products e.g. antacids, supplements or feeds containing calcium, iron, magnesium, zinc, sucralfate or bismuth. These products bind to doxycycline and reduce its absorption by over 90%.
If patients are prescribed antacids or supplements containing calcium iron, magnesium zinc or bismuth. It is advised these medications are stopped/withheld for the duration of antibiotic treatment. If this is not possible due to a clinical need, then an alternative antibiotic must be considered.
If doxycycline and a cation containing product must be prescribed together:
· Administration times should be as far apart as possible
· Reduce the dosing frequency of the interacting product if possible
· In the case of oral nutritional supplements, multiple sips throughout the day should be replaced with set administration times to enable adequate spacing from oral antibiotic administration
· If a patient is receiving an enteral feed doxycycline should generally be avoided unless there is a specific feed free window