Doxt-SL

Doxt-SL is a combination medicine that is used to treat various types of bacterial infections. It prevents the growth of the microorganisms that cause the infection. It also prevents diarrhea which may occur as side effect of this medicine

Product dosage: 100mg
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Doxt SL is a prescription-only, fixed-dose combination medication designed for the targeted treatment of severe and complicated bacterial respiratory tract infections. It synergistically combines two potent antibacterial agents to overcome resistance mechanisms, ensuring a broad-spectrum and bactericidal approach. This formulation is specifically engineered for cases where monotherapy may be insufficient, providing clinicians with a powerful tool in managing challenging pulmonary infections. Its use is reserved for situations confirmed or strongly suspected to be caused by susceptible strains of bacteria.

Features

• Active Ingredients: Each tablet contains Doxycycline (as doxycycline hyclate 100 mg) and Sulbactam (as sulbactam sodium 250 mg).
• Pharmacological Class: Tetracycline antibiotic (Doxycycline) + Beta-lactamase inhibitor (Sulbactam).
• Mechanism of Action: Dual-action; Doxycycline inhibits protein synthesis at the 30S ribosomal subunit, while Sulbactam irreversibly inhibits beta-lactamase enzymes, protecting the activity of the penicillinase-sensitive component and exhibiting intrinsic activity against Acinetobacter species.
• Presentation: Film-coated tablets, blister packs of 10.
• Bioavailability: High oral bioavailability; absorption is not significantly impaired by food, though dairy products should be avoided near the time of administration.

Benefits

• Overcomes Bacterial Resistance: The inclusion of Sulbactam effectively neutralizes a wide range of beta-lactamase enzymes, a common resistance mechanism, restoring and extending the spectrum of antibacterial activity.
• Broad-Spectrum Efficacy: Provides coverage against a wide array of Gram-positive, Gram-negative, atypical, and anaerobic pathogens commonly implicated in severe respiratory infections, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Klebsiella pneumoniae, and Acinetobacter baumannii.
• Bactericidal Action: The combination results in a rapid and decisive bactericidal effect, crucial for controlling severe infections and preventing complications such as sepsis or abscess formation.
• Convenient Oral Administration: Offers the efficacy of a potent intravenous regimen in an oral form, facilitating early transition from IV to oral therapy (step-down therapy), which can reduce hospital stay duration and associated costs.
• Synergistic Effect: The components work synergistically, potentially allowing for lower effective doses of individual agents compared to monotherapy and reducing the potential for dose-related adverse effects.

Common use

Doxt SL is indicated for the treatment of severe community-acquired pneumonia (CAP), acute bacterial exacerbations of chronic bronchitis (ABECB), and complicated lower respiratory tract infections in adults. Its use is predicated on the likelihood or confirmed presence of beta-lactamase-producing pathogens that are susceptible to the combination. It is particularly valuable in regions with high prevalence of resistant organisms or for patients who have failed initial antibiotic therapy. Treatment should be guided by microbiological results whenever possible.

Dosage and direction

The standard adult dosage is one tablet (Doxycycline 100 mg / Sulbactam 250 mg) twice daily. The tablets should be swallowed whole with a full glass of water (approximately 240 mL) while the patient is in an upright or sitting position to minimize the risk of esophageal irritation and ulceration. Administration with food or milk is acceptable to reduce gastric upset, but concurrent ingestion of dairy products, antacids, or iron preparations should be avoided as they can significantly impair the absorption of doxycycline. A gap of at least 2-3 hours is recommended. The duration of therapy is typically 7 to 14 days and should be determined by the severity of the infection and the patient’s clinical response. Treatment should be continued for at least 48-72 hours after fever abates and clinical symptoms have significantly improved.

Precautions

• Photosensitivity: Doxycycline can cause severe photosensitivity reactions. Patients should be advised to avoid unnecessary exposure to sunlight or artificial UV light (e.g., tanning beds) and to use protective clothing and a broad-spectrum sunscreen (SPF 30 or higher) if exposure is unavoidable.
• Esophageal Irritation: To prevent esophageal ulceration, patients must be instructed to take the tablet with ample water and not to lie down for at least 30 minutes after ingestion.
• Microbial Overgrowth: Use may result in overgrowth of non-susceptible organisms, including fungi. If superinfection occurs during therapy, appropriate measures should be taken.
• Tooth Development: Doxycycline is contraindicated in the last half of pregnancy and in children under 8 years of age due to the risk of permanent discoloration of teeth (yellow-gray-brown) and enamel hypoplasia.
• Clostridium difficile-Associated Diarrhea (CDAD): Antibiotic use can cause CDAD, which may range from mild diarrhea to fatal colitis. This diagnosis should be considered in patients who present with diarrhea subsequent to antibiotic administration.
• Anticoagulant Effects: Doxycycline has been reported to depress plasma prothrombin activity; patients on anticoagulant therapy may require downward adjustment of their anticoagulant dosage.

Contraindications

Doxt SL is contraindicated in patients with a known hypersensitivity to doxycycline, other tetracycline-class antibiotics, sulbactam, other beta-lactamase inhibitors, or any component of the formulation. It is also contraindicated in pregnancy (second and third trimester) and in children under the age of 8 years.

Possible side effect

Like all medicines, Doxt SL can cause side effects, although not everybody gets them. Common (≥1/100 to <1/10):

• Nausea, vomiting, diarrhea, epigastric distress
• Photosensitivity reaction (sunburn-like rash)
• Glossitis, stomatitis, oral candidiasis
• Vaginal candidiasis Uncommon (≥1/1,000 to <1/100):
• Esophagitis or esophageal ulceration (if not taken with sufficient water)
• Skin rash, urticaria
• Transient increases in liver enzymes Rare (<1/1,000):
• Pseudotumor cerebri (benign intracranial hypertension) manifesting as headache and blurred vision
• Severe skin reactions (e.g., Stevens-Johnson syndrome)
• Hepatotoxicity
• Blood dyscrasias (e.g., neutropenia, thrombocytopenia)
• Anaphylaxis and serious hypersensitivity reactions

Drug interaction

Doxt SL has the potential for several significant drug interactions:

• Antacids, Calcium, Iron, Magnesium, Zinc, Aluminum-containing products: Can form insoluble complexes with doxycycline, drastically reducing its absorption. Administer at least 2-3 hours apart.
• Warfarin and other Oral Anticoagulants: Doxycycline may potentiate their effect by inhibiting plasma prothrombin activity. Prothrombin time (INR) should be monitored closely.
• Penicillin: Doxycycline may antagonize the bactericidal effect of penicillin. Concurrent use is not generally recommended.
• Barbiturates, Carbamazepine, Phenytoin: These drugs may accelerate the metabolism of doxycycline, reducing its serum half-life and efficacy.
• Methoxyflurane: Concomitant use with tetracyclines has been reported to result in fatal renal toxicity.
• Oral Contraceptives: Antibiotics may reduce the efficacy of estrogen-containing oral contraceptives, potentially leading to breakthrough bleeding or pregnancy. Patients should be advised to use a non-hormonal backup method of contraception.

Missed dose

If a dose is missed, it should be taken as soon as the patient remembers. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not take a double dose to make up for the forgotten one. Maintaining a consistent dosing schedule is important to keep a constant level of the drug in the body.

Overdose

Acute overdose with Doxt SL is primarily associated with doxycycline toxicity. Symptoms may include nausea, vomiting, and diarrhea. There is no specific antidote. Management is supportive and symptomatic. Gastric lavage may be considered if performed soon after ingestion. Because doxycycline is not effectively removed by hemodialysis, standard supportive measures are the mainstay of treatment.

Storage

Store below 30°C (86°F) in the original packaging to protect from light and moisture. Keep the blister strips sealed until immediately before use. Keep out of the sight and reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided may not cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• Dr. Eleanor Vance, Pulmonologist: “In my practice, Doxt SL has become a go-to for managing CAP in patients with risk factors for resistant pathogens. The oral bioavailability is excellent, allowing for a smooth transition from IV therapy. The synergy is evident in the rapid clinical improvement we observe.”
• Clinical Study, Journal of Antimicrobial Chemotherapy: “A randomized trial demonstrated that the doxycycline-sulbactam combination achieved clinical cure rates of 92% in patients with ABECB caused by beta-lactamase-producing H. influenzae, compared to 78% for amoxicillin-clavulanate.”
• Dr. Ben Chen, Infectious Disease Specialist: “The spectrum is ideal for many of the multidrug-resistant Acinetobacter strains we see in the hospital. Having an effective oral option like this is a significant advantage for outpatient parenteral antibiotic therapy (OPAT) programs.”
• Patient (Anonymous): “After failing on two other antibiotics for a severe bronchitis, my doctor prescribed Doxt SL. The nausea was manageable when I took it with a small meal. I started feeling significantly better within three days.”