QUESTION 1: Teething issues: can doxycycline be safely used in young children?

A 6-year-old girl presents with fever, rash and arthralgia 1 week after returning from a camping trip to South Africa. After exclusion of other potential diagnoses, her rickettsia serology is found to be positive and you decide to prescribe a course of doxycycline. However, the package insert states that doxycycline is contraindicated in children <8 years of age as it ‘may cause enamel loss and staining in developing teeth’. You wonder ‘what is the risk of dental side effects?’ In children <8 years of age (patient), does treatment with doxycycline (intervention) confer a risk of permanent dental staining (outcome)? MEDLINE and EMBASE were searched in March 2016 using the OVID interface. The following terms were used: doxycycline.af, exp tooth diseases, exp tooth abnormalities, tooth calcification, exp tooth development, tooth colour, tooth colour and enamel. The search was limited to English language studies in humans. This identified 1057 studies of which four included children under 8 years of age exposed to doxycycline (table 1). The references of all articles were reviewed and no additional studies were identified. View this table: Table 1 Summary of evidence Tetracycline antibiotics were first introduced in the 1950s and have broad-spectrum activity against Gram-positive and Gram-negative bacteria. They are used for the treatment …