Misperceptions Keep Kids from Getting Lifesaving Drug for Tickborne Diseases

Children are five times more likely than adults to die from tickborne diseases like Rocky Mountain spotted fever (RMSF). Doctors often avoid prescribing doxycycline, the most effective RMSF treatment, for young children because the drug’s warning label cautions that tooth staining may be a side effect in children younger than eight years. A new study suggests that for patients with RMSF, this warning may be doing more harm than good. The study led by experts at the CDC and Indian Health Service (IHS) found that short courses of the antibiotic doxycycline can be used in children under eight years old without staining teeth or weakening tooth enamel.


The CDC and IHS researchers reviewed medical records for more than 250 children who lived on an American Indian reservation with high rates of RMSF. Dentists inspected the permanent teeth of children who had received doxycycline for suspected RMSF before their eighth birthday and those who had not, without knowing which children had received the drug. The dentists evaluated tooth color and looked for tooth staining and evidence of weakness in the tooth enamel of all children in the study. They found no differences between the two groups in tooth color, staining, or enamel.


Since 1970, all tetracycline-class antibiotics, including doxycycline, have included a warning label from the FDA advising against their use in children younger than eight because of the risk of tooth staining. Previous studies of children who received older tetracyclines identified staining or tooth problems in 23 to 92 percent of recipients. The current study is the largest conducted to date that examines whether doxycycline negatively affects dental health and the first to use instruments to measure tooth color.


Treating RMSF is a race against time, and doctors must prescribe the drug early, before they have lab results confirming infection. “Many doctors readily use doxycycline to treat suspected RMSF in adults but won’t use the drug in children, because they’re worried about tooth staining and hesitate to prescribe it for only a suspected case,” said Dr. Jennifer McQuiston, a CDC epidemiologist and one of the study’s authors. “Our study shows definitively that this shouldn’t be a reason to avoid this life-saving drug. Changing the drug’s label may encourage physicians to use doxycycline earlier to treat suspected RMSF in children, which will help save lives.”


The CDC recommends starting doxycycline treatment as soon as a doctor suspects RMSF or other rickettsial infection. Delaying treatment after the start of the infection increases the patient’s risk of hospitalization and death.


More than 13,500 cases of RMSF and related infections were reported in the United States between 2008 and 2012. Children under ten years old represented only six percent of the reported cases, but accounted for nearly a quarter of the RMSF deaths during that period, highlighting the importance of early pediatric treatment.


RMSF is a severe tickborne disease caused by the bacterium Rickettsia rickettsii. This organism is a cause of potentially fatal human illness in North and South America, and is transmitted to humans by the bite of infected tick species. In the United States, these include the American dog tick, Rocky Mountain wood tick, and brown dog tick. Typical symptoms include: fever, headache, abdominal pain, vomiting, and muscle pain. A rash may also develop, but is often absent in the first few days, and in some patients, never develops. More than 20 percent of untreated cases are fatal. The average time from the beginning of symptoms to death is eight days.


In addition to improving survival from RMSF, the news that short courses of doxycycline are not linked to dental concerns in kids might also improve treatment of other infections. Doxycycline is also effective against some bacteria that commonly cause community-acquired pneumonia.


See the CDC Announcement


See also Medical Law Perspectives, April 2014 Report: Danger and Controversy: Lyme Disease Liability Risks


See also Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication