Doxycycline induced oesophageal ulcers in a navy ship crewmember

Abstract

A healthy 25-year-old crewmember of a navy ship was diagnosed with suspected pneumonia and prescribed 100 mg twice a day of doxycycline for 10 days. During the 7th day of treatment the patient joined his navy ship to sail aboard and 2 days later, immediately after taking the doxycycline capsule, he felt a forceful pain in the median chest which was followed with odynophagia of both solid foods and liquids. The patient adhered to the administration guidelines of the doxycycline, except drinking 330 mL of beer, 3 h before taking the capsule. A working diagnosis of atypical chest pain, possibly due to oesophagitis, was made. The patient was advised to fast and rest and treatment with intravenously (IV) H2-receptor antagonist, clear fluids and analgesics was started. Later on, due to lack of improvement in the patient's status and the potential risk of future deterioration, a decision was made to evacuate the patient to a hospital. Gastroscopy, revealed 3 ulcers in the mid-oesophagus and the patient was hospitalised for treated of IV antacids and fluids with gradual improvement. This case emphasizes the limitation of diagnosing and treating a common side effect in the middle of the sea and the potential risk in taking medications with alcohol.

Doxycycline‐induced oesophageal ulcer in a teenager: A case report

“…The mechanism of injury is likely to be due to a caustic burn secondary to direct mucosal contact with the offending drug, and it is noted that doxycycline is a relatively large‐sized tablet with a low pH (pH < 3). The ulcer usually occurs at the narrowest segment of the oesophagus, commonly in the mid‐oesophagus region, where the oesophagus passes behind the aortic arch and the left bronchus, as found in our patient. Risk factors associated with pill oesophagitis include a supine position at the time of pill ingestion, a large‐sized capsule/pill, inadequate fluid ingested with the drug, oesophageal motility problems and anatomical or pathological strictures .…”

“…The ulcer usually occurs at the narrowest segment of the oesophagus, commonly in the mid‐oesophagus region, where the oesophagus passes behind the aortic arch and the left bronchus, as found in our patient. Risk factors associated with pill oesophagitis include a supine position at the time of pill ingestion, a large‐sized capsule/pill, inadequate fluid ingested with the drug, oesophageal motility problems and anatomical or pathological strictures . Doxycycline comes with specific written instructions: ‘take with adequate fluids (≥100 mL), preferably in morning and to remain in upright position post ingestion’…”

“…tetracycline, doxycycline), non‐steroidal anti‐inflammatory drugs (e.g. aspirin), bisphosphonates and slow‐release potassium chloride use (Box ) . Antibiotics, particularly doxycycline, are considered to be the most common cause of drug‐induced oesophagitis, with one report attributing 50% of cases to doxycycline …”

Doxycycline use in maritime-medical practices

“…The authors also speculate that intake of 330 mL beer several hours before taking the doxycycline capsule may have contributed to the oesophageal condition [8].…”

“…In this issue of "International Maritime Health", Rottenstreich, Rottenstreich and Shapira [8] present a naval crewmember who was diagnosed with oesophageal ulcers after taking doxycycline by mouth, thought to be caused by low pH and slow passage of the capsule through oesophagus. In most previously reported cases horizontal patient position and too little concomitant fluid intake may have been contributing factors, whereas the present patient had been instructed to take the capsule with a glass of water and to sit up for at least 30 min afterward.…”