How to Prepare Emergency Dosages of 
Doxycycline at Home for Infants and Children

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• Introduction
• Bitter Pills
• Mixing and Dissolving Doxycycline Tablets
• How to Mix 100 milligram (mg) Doxycycline with a food or drink
• Doses: How Much of the Doxycycline Mixture To Give A Child
• Dosing Chart for Doxycycline Mixture

Once you have been notified by your federal, state, or local authorities that you have been exposed to anthrax, it may be necessary to prepare emergency doses of doxycycline for infants and children using doxycycline tablets.

The antibiotic doxycycline is used to treat anthrax and several other types of infections. Doxycycline is not generally given to children under eight years old because it can permanently discolor teeth and cause problems with tooth enamel. It may also cause delays in bone development in premature babies if taken for a long time. Bone development seems to return to normal when the medicine is stopped.

For most people, doxycycline’s benefit of preventing children from becoming ill with anthrax outweighs the problems it can cause to teeth and bones. The Food and Drug Administration is providing information to caregivers who choose to give doxycycline to children who have been exposed to inhalational anthrax.

Most of the doxycycline stockpiled by the government is in tablet form. Tablets are easier to store. Some doxcycline is already stored in liquid form for infants and children but in an emergency, there may be the need to dissolve tablets into a mixture.

Children generally don’t enjoy swallowing pills. FDA tried some foods and drinks to see what can mask the taste of a crushed doxycycline tablet. This document explains how to mix a crushed doxycycline tablet with food or a drink, which foods and drinks work best, and how much to give to a child.

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Doxycycline can be dissolved in water, but water does not mask the bitterness. FDA tried mixing doxycycline with the following foods and drinks:

• lowfat white milk
• lowfat chocolate milk
• regular (whole) chocolate milk
• chocolate pudding
• grape jelly
• strawberry jelly
• yogurt with cherry flavor
• apple juice mixed with table sugar

The following foods and drinks mixed with doxycycline generally have an acceptable taste:

• lowfat white milk
• lowfat chocolate milk
• regular (whole) chocolate milk
• chocolate pudding
• apple juice mixed with table sugar

The following foods mixed with doxycycline do not hide its bitterness:

• jellies
• yogurt

Here are some points to keep in mind:

• Drinks work better than soft foods like pudding or jelly to dissolve the doxcycline tablet.
• Adding sugar to apple juice will help the mixture taste better.
• Extra sugar is not needed with sweet foods like chocolate milk and pudding.
• Chocolate milk and chocolate pudding hide the taste of doxycycline better than juice.

Note: To find out how much of this mixture to give a child, use the Dosing Chart below.

The following instructions should be followed using measuring spoons that measure one (1) teaspoon and one half (½) teaspoon, if they are available. If measuring spoons are not available, please use the same metal teaspoon to grind the tablet, measure the food or drink, and give the medicine. For example, if you don’t have a measuring spoon to give the child one and a half (1 ½) teaspoons of the medicine mixture, use the metal teaspoon to estimate as best you can. Because the amount of fluid is so small in a half teaspoon, it is better to give a little extra of the half teaspoon than not enough.

• One (1) 100-mg doxycycline tablet
• A metal teaspoon
• Measuring spoons [one (1) teaspoon; and one half (½) teaspoon], if available
• 1 or 2 Small bowls
• One of these foods or drinks:
  • lowfat milk
  • lowfat chocolate milk
  • regular (whole) chocolate milk
  • chocolate pudding
  • apple juice mixed with table sugar*

Put one (1) 100-mg doxycycline tablet into a small bowl and grind it into a fine powder using the back of the metal teaspoon. The powder should not have any large pieces.

Use a measuring spoon to add four (4) level teaspoons of a food or drink to the doxycycline powder in the small bowl. Mix them together until the doxycycline powder dissolves. It may be harder to dissolve the powder in pudding than in a drink.

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Adults (and children heavier than 100 pounds) who are exposed to anthrax should take one (1) 100-mg tablet of doxycycline twice a day for 60 days (2 tablets per day).

The number of teaspoons of the doxycycline mixture to give a child depends on the child’s weight. Use the chart below to see how much to give a child.

Doxycycline mixed with any of the recommended foods and drinks will keep for at least 24 hours. Store the mixture in a covered container and always refrigerate mixtures made with milk or pudding. Mixtures made with juice can be stored at room temperature. FDA recommends that doxycycline mixtures be prepared daily; unused portions should be thrown away.

For more information about doxycycline, go to "Doxycycline and Penicillin G Procaine for 
Inhalational Anthrax (Post-Exposure)" at www.fda.gov/cder/drug/infopage/penG_doxy