The antibiotic doxycycline belongs in the tetracycline family and treats a wide range of infections ranging from the mundane to the unusual. This broad spectrum drug treats acne, rosacea and staphylococcal abscesses equally as well as some atypical pneumonias, Chlamydia, early Lyme disease, cat scratch disease, syphilis and spotted fever. It even prevents cutaneous or inhalation anthrax after exposure and may be used as prophylaxis against malaria for short term travel to endemic areas.

Unfortunately excessive prescriptions of antibiotics have allowed bacteria to become increasingly resistant to medication. Doxycycline once provided reliable treatment for infections due to Strep. pneumoniae, Shigella and the organism responsible for gonorrhea. This no longer is true.

Doxycycline acts as a bacteriostatic drug often wounding or slowing bacterial growth rather than outright killing them. For this reason, combination therapy with antibiotics in the penicillin family should be avoided. Penicillin and derivatives such as amoxicillin and ampicillin actually are bactericidal and kill the bacteria.

Two major forms of doxycycline exist: doxycycline hyclate and doxycycline monohydrate. Brand names and generic preparations of each are available. While some differences exist regarding solubility, once absorption occurs, both provide the same active ingredient. Selection among the options should be based on price, availability and compatibility with one’s system.

Due to a combination of factors including manufacturing issues, 2013 marked the year when the price of generic doxycycline soared. The wholesale commercial price of a bottle of 500 pills that previously sold for $20 witnessed a price escalation to nearly $1800. Obviously the retail price and copay for the consumer at the pharmacy spiraled upward in parallel. While the price eventually moderated, it remains considerably more expensive than during the early 2000s.

Pharmaceutical companies continue to charge an amazing premium for their iteration of much cheaper generics. For example with a discount coupon from goodrx.com the cash price for a 10 day course of Vibramycin is about $250, Monodox $400, Doryx $1300, Oracea $725 and Acticlate $740. With much less expensive, equally effective alternative therapy so readily available, the reason for such continued price gouging remains unanswered.