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Doxycycline Oesophagitis Prevention — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipDoxycycline Oesophagitis PreventionSCE Infectious Diseases

A 55-year-old man on long-term Doxycycline for chronic Q fever endocarditis develops pill oesophagitis with dysphagia and retrosternal pain. What counselling point should have been given at prescription?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Take Doxycycline with a full glass of water while sitting upright and remain upright for at least 30 minutes afterwards — to prevent oesophageal mucosal irritation

Doxycycline (and all tetracyclines) can cause severe oesophageal ulceration if tablets lodge in the oesophagus. Key counselling points: take with a full glass of water (not just a sip), remain upright (sitting or standing) for at least 30 minutes after taking, and do NOT take immediately before lying down/bed. Taking with food reduces GI upset and improves absorption (unlike older tetracyclines). Milk and antacids should be avoided (chelation reducing absorption). This is particularly important for patients on long-term Doxycycline (Q fever, acne, malaria prophylaxis).

Reference: BNF 2024 – Doxycycline; NICE CKS 2024