Is It OK to Take Doxycycline Every Day Forever?

May 28, 2022 9:36 AM

An ophthalmologist prescribed me a daily dose of 100mg of doxycycline to keep my blepharitis under control. I've been taking it for 10 years. My new doctor is advising that I wean myself off it. But it's the only thing that has worked!

About 10 years ago I started getting these giant styes that wouldn't go away with normal treatment (warm compress, etc.) I found a combination ophthalmologist / optical plastic surgeon who would surgically remove them (ick!) and who diagnosed me with blepharitis - basically, I have thick eye mucous that clogs my eyelid glands.

She prescribed me a daily dose of 100mg of doxycycline as a preventive measure. She explained that though blepharitis isn't an infection, there's something about doxycycline that keeps the eye oils more viscous and prevents them from clogging up the glands and producing these styes.

This seems to be working. I went several years without getting a new stye. But a few years back I got worried about the effects of long-term antibiotic use so I scaled back the dosage and then eventually went a week or so without taking it ... and promptly got a giant stye that she needed to slice off.

She has recently retired, and my new eye doc is telling me it's not a good idea to take antibiotics every day forever and is basically saying: "Just live with occasional giant eye tumors and treat them with warm compresses." I'm concerned that he's not going to refill my prescription when it expires. But I'm also concerned that he's right and I shouldn't be taking an antibiotic every day for the rest of my life.

Medical Internet ranges from inconclusively sharing my concern to saying there's nothing to worry about to basically saying I'm lucky I'm not dead yet (exaggeration). I'm interested in hearing from people who are also doing this or from medical professionals who have experience with this situation.

For the record, I have had zero noticeable side effects to the doxy, except I get even more easily sunburned than usual. I'm male, so yeast infections and interactions with hormone-based birth control are not a concern. I take it in the morning with water and food. And I haven't ever had malaria, but I suppose living in the Pacific Northwest might also have something to do with that.

posted by majorsteel to Health & Fitness (10 answers total)

Cochrane is "uncertain" in a couple of papers on this issue FWIW.
posted by lalochezia at 9:51 AM on May 28, 2022 [1 favorite]

I just got through a very nasty bout of C Diff that has made me a lot more cautious about antibiotics. (I got if after a round of doxy.) Not sure it's a reason not to take it if it works for you, but something to consider.
posted by jeszac at 9:52 AM on May 28, 2022 [1 favorite]

Best answer: I also take daily doxy. My dermatologist, who prescribed it, tells me that my 50 mg / day dose is subclinical for antibiotic activity—in other words, there’s not enough of the drug in my system to act as an antibiotic and I’m only getting the anti-inflammatory and skin oil reduction effects.

She also told me that a 100 mg / dose is right on the edge of what she would consider subclinical. She doesn’t love prescribing indefinite antibiotic use, but if it’s what works, it’s what works. We did spend some time trying out different doses to find the minimum effective dose.
posted by mr_roboto at 10:15 AM on May 28, 2022 [4 favorites]

Best answer: Doctors who aren’t familiar with low-dose use of doxycycline to manage inflammation sometimes react as if you’re telling them you’re taking a full-dose antibiotic indefinitely. I’d get a second opinion from someone better versed in chronic illness. I have no idea if you should be taking doxycycline (IANAD), but given the relief it’s brought you, it’s worth consulting with someone who can take a more nuanced approach than “long term antibiotic use is bad.”
posted by theotherdurassister at 10:17 AM on May 28, 2022 [8 favorites]

Best answer: I have had similar issues and have been on 50 mg of Doxycycline for the last six months. It is the only thing that has ever worked and I’ve had my eye problems for decades. They can take it from my cold dead hands. The difference in my quality of life is night and day and that’s even with a touch of chronic thrush that it brings.
posted by norm at 10:18 AM on May 28, 2022 [1 favorite]

Have you tried doxy as an ophthalmic solution instead?
posted by Ardnamurchan at 10:58 AM on May 28, 2022

Response by poster: Thank you all so far. I haven't tried lowering the dosage on a regular basis; maybe that's a good step to try next. But I'm significantly less concerned after hearing from those of you who are also doing this.
posted by majorsteel at 12:04 PM on May 28, 2022

I've had chronic blepharitis for years myself, and I'm wondering about whether a combo of lower-dose doxy plus omega-3s (like flaxseed or fish oil) would help keep your glands flowing and also keep you out of bacterial resistance trouble. I don't take doxy myself (eye doc put me on it once and I had a bad reaction) but the omega-3 from a nightly flaxseed oil supplement of 500 mg has been helpful. I stopped taking the flaxseed once to see what would happen and I had immediate trouble, so I suspect it's actually doing something. YMMV, IANYD, EIEIO.

Also, I'm feel grumpy about the warm compress advice you got. Practically useless for me.

I did occasional BlephEx treatments for a while, but I also fiddled with my diet for unrelated reasons and happened to discover that my blepharitis improved with some changes to reduce overall bodily inflammation. In my case, the main culprit for inflammation was wheat.
posted by sockshaveholes at 3:45 PM on May 28, 2022 [1 favorite]

I’m no doctor, and take 100mg doxy daily for rosacea acne. My Dr said I could try 50 and see how that goes. I tried to find out if there are long term negative effects and everything I could find essentially said that doxy works by some other mechanism on face bacteria, like not the way that antibiotics usually kill other bacteria, and that it was effective down to 40mg a day. Enough so that some pharma companies were working on an official lower dose like that.

That helped me rest easy.
posted by MonsieurBon at 4:59 PM on May 28, 2022

No info on doxy, but like sockshaveholes, I’m on flaxseed oil at my opthamologist’s direction, and I do think it helps. He also said that warm compresses are useless unless 1. pretty darn hot and 2. immediately followed by hard pressure massage of the area — about as hard as you can bear. You’re trying to dislodge a waxy cap that the heat softens. He suggests 10 minutes at a time of heat, 4x per day, for 4 days before giving up. This has sometimes worked for me.
posted by daisyace at 6:55 AM on May 29, 2022 [1 favorite]