Doxycycline-induced esophageal ulceration in the US military service

U.S. military forces are frequently deployed with little warning to regions of the world where chloroquine-resistant malaria Is endemic, Doxycycline i s often used for malaria chemoprophylaxis in these environments. The use of doxycycline can be complicated by esophageal injury. Two cases of esophage al ulceration will be discussed, followed by a review of the literature, Do xycycline causes esophageal injury through a combination of drug-specific f actors, the circumstances of drug administration, and individual patient co nditions. Patients with dysphagia attributable to esophageal ulceration are managed by intravenous fluid support and control of gastric acid reflux un til their symptoms resolve over 5 to 7 days. The risk of esophageal injury can be minimized by use of fresh capsules, drug administration in the uprig ht position well before lying down to sleep, and drinking at least 100 ml o f water after swallowing the medication.