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Resumo Das Características Do Medicamento 1. Nome Do RESUMO DAS CARACTERÍSTICAS DO MEDICAMENTO 1. NOME DO MEDICAMENTO Vibramicina 100 mg comprimidos dispersíveis. 2. COMPOSIÇÃO QUALITATIVA E QUANTITATIVA Cada comprimido dispersível contém 106,045 mg de doxiciclina mono-hidratada equivalente a 100 mg de doxiciclina base. Lista completa de excipientes, ver secção 6.1. 3. FORMA FARMACÊUTICA Comprimido dispersível. 4. INFORMAÇÕES CLÍNICAS 4.1 Indicações terapêuticas A doxiciclina está indicada para o tratamento das seguintes infeções causadas por microrganismos sensíveis, nomeadamente: Infeções do trato respiratório Pneumonia adquirida na comunidade; Exacerbação bacteriana aguda da bronquite crónica; Sinusite bacteriana. Infeções do trato urinário Infeções não complicadas do trato urinário. Doenças sexualmente transmissíveis Linfogranuloma venéreo causado por Chlamydia trachomatis; Infeções uretrais, endocervicais ou retais, não complicadas, causadas por Chlamydia trachomatis; Epidídimo-orquite aguda causada por Chlamydia trachomatis ou Neisseria gonorrhoeae; Granuloma inguinal (Donovanose) causado por Calymmatobacterium granulomatis; Uretrite não gonocócica (UNG) causada por Ureaplasma urealyticum (T-Mycoplasma); A doxiciclina é uma alternativa no tratamento de sífilis causada por Treponema pallidum e gonorreia não complicada causada por Neisseria gonorrhoeae. Infeções cutâneas e dos tecidos moles Infeções cutâneas e dos tecidos moles. Na acne grave a doxiciclina pode ser uma terapêutica adjuvante útil. A doxiciclina é uma alternativa no tratamento de framboesia causada por Treponema pertenue. Infeções oculares Tracoma causado por Chlamydia trachomatis, embora nem sempre o agente infecioso seja eliminado, conforme demonstrado por imunofluorescência. A conjuntivite de inclusão causada por Chlamydia trachomatis pode ser tratada com doxiciclina por via oral, administrada isoladamente ou em associação com agentes tópicos. Rickettsiose Febre das montanhas rochosas, tifo e grupo do tifo, febre Q, rickettsiose varicelosa e febres da carraça causadas por Rickettsiae. Outras infeções Psitacose causada por Chlamydia psittaci; Brucelose causada por Brucella sp. (associada a outro antibacteriano, como a estreptomicina ou a rifampicina); Cólera causada por Vibrio cholerae; Malária causada por Plasmodium falciparum (nas zonas onde haja resistência de Plasmodium falciparum à cloroquina); Leptospirose causada pelo género Leptospira; Na amebíase intestinal aguda, a doxiciclina pode ser um útil adjuvante dos amebicidas; Carbúnculo causado por Bacillus anthracis, incluindo carbúnculo por inalação (pós-exposição): para reduzir a incidência ou progressão da doença após exposição ao Bacillus anthracis através de aerossóis; Peste causada por Yersinia pestis; Estádio inicial da doença de Lyme (Estádio 1 e 2) causada por Borrelia burgdorferi; Febre recorrente do piolho causada por Borrelia recurrentis; Febre recorrente da carraça causada por Borrelia duttonii. A doxiciclina está também indicada para o tratamento de infeções causadas pelos seguintes microrganismos Gram-negativo: - Acinetobacter sp.; - Bacteroides sp.; - Fusobacterium sp.; - Tularemia causada por Francisella tularensis; - Bartonelose causada por Bartonella bacilliformis; - Campylobacter fetus. Quando a penicilina está contraindicada, a doxiciclina é uma alternativa no tratamento de: - Actinomicose causada por Actinomyces sp.; - Infeções causadas por Clostridium sp.; - Listeriose causada por Listeria monocytogenes; - Angina de Vincent (gengivite ulcerativa necrosante aguda) causada por Leptotrichia buccalis (anteriormente Fusobacterium fusiforme). A doxiciclina está indicada na profilaxia das seguintes situações: tifo rural da Malásia causado por Rickettsia tsutsugamushi; diarreia do viajante causada por Escherichia coli enterotóxica, leptospirose e malária. Devem ser tomadas em consideração as orientações nacionais e/ou locais sobre o uso apropriado dos medicamentos antibacterianos. 4.2 Posologia e modo de administração Posologia Convém recordar que a doxiciclina difere de outras tetraciclinas, no que diz respeito à dose usual e à frequência da administração. Quando se excede a dose recomendada a incidência de efeitos secundários pode aumentar. Depois dos sintomas e da febre terem desaparecido, o tratamento deve prosseguir durante, pelo menos, mais 24 a 48 horas. Nas infeções estreptocócicas, o tratamento deve manter-se durante 10 dias, a fim de prevenir o desenvolvimento de febre reumática ou de glomerulonefrite. A dose usual de doxiciclina no doente adulto é de 200 mg no primeiro dia de tratamento (administrada de uma só vez ou dividida em duas tomas de 100 mg com o intervalo de 12 horas) seguida de uma dose de manutenção de 100 mg diários (administrada de uma só vez ou dividida em duas tomas de 50 mg com o intervalo de 12 horas). No tratamento de infeções mais graves (particularmente infeções crónicas do trato urinário), a dose diária de 200 mg deve manter-se durante todo o tratamento. Crianças de idade superior a 8 anos: Em crianças com peso igual ou inferior a 45 kg a dose recomendada é de 4,4 mg/kg de peso corporal (administrados diariamente de uma só vez ou divididos em duas tomas no primeiro dia de tratamento), seguida de 2,2 mg/kg de peso corporal (administrados diariamente de uma só vez ou divididos em duas tomas) nos dias seguintes. No tratamento de infeções mais graves pode usar-se uma dose diária até 4,4 mg/kg de peso corporal. As crianças com peso superior a 45 kg devem ser medicadas com a dose para adultos (ver secção 4.4 Utilização em crianças). Recomendações posológicas em infeções específicas: A febre recorrente do piolho e da carraça e o tifo causado por piolho têm sido tratados com êxito com uma dose única de 100 mg ou 200 mg, de acordo com a gravidade, administrada por via oral. Como alternativa para diminuir o risco de persistência ou recorrência da febre recorrente da carraça, é recomendada a administração de 100 mg de doxiciclina a cada 12 horas, durante 7 dias. Estádio inicial da doença de Lyme (Estádio 1 e 2): 100 mg de doxiciclina administrados duas vezes por dia, por via oral, durante 14-60 dias, de acordo com os sinais clínicos, sintomas e resposta. Infeção uretral, endocervical ou retal, não complicada, no adulto, causada por Chlamydia trachomatis: 100 mg, por via oral, duas vezes ao dia, durante 7 dias. Epidídimo-orquite aguda causada por C. trachomatis ou N. gonorrhoeae: 250 mg intramuscular (IM) de ceftriaxona ou outra cefalosporina adequada em dose única, juntamente com 100 mg de doxiciclina por via oral, duas vezes ao dia, durante 10 dias. Uretrite não gonocócica (UNG) causada por Chlamydia trachomatis ou Ureaplasma urealyticum: 100 mg por via oral, duas vezes ao dia, durante 7 dias. Linfogranuloma venéreo causado por Chlamydia trachomatis: 100 mg de doxiciclina, por via oral, duas vezes ao dia, durante 21 dias no mínimo. Infeções gonocócicas não complicadas do colo do útero, reto ou uretra, nas quais os gonococos permanecem totalmente sensíveis: recomenda-se 100 mg de doxiciclina, por via oral, duas vezes ao dia, durante 7 dias, juntamente com o co-tratamento com uma cefalosporina ou quinolona adequadas, tais como as seguintes: cefixima 400 mg por via oral em dose única, ou ceftriaxona 125 mg IM em dose única, ou ciprofloxacina 500 mg, por via oral, em dose única ou ofloxacina 400 mg, por via oral, em dose única. Infeções gonocócicas não complicadas da faringe, nas quais os gonococos permanecem totalmente sensíveis: recomenda-se doxiciclina 100 mg por via oral, duas vezes ao dia, durante 7 dias, juntamente com uma cefalosporina ou quinolona adequadas, tais como as seguintes: ceftriaxona 125 mg IM em dose única, ou ciprofloxacina 500 mg, por via oral, em dose única ou ofloxacina 400 mg, por via oral, em dose única. Propõe-se que seja utilizada, no tratamento empírico de algumas infeções sexualmente transmissíveis, a associação de uma cefalosporina ou de uma quinolona com doxiciclina, de modo a alargar o espetro de ação antibacteriano e diminuir a possibilidade de falência terapêutica por desenvolvimento de Nesseria gonorrhoeae com resistência a antibióticos. Sífilis primária e secundária: Os doentes alérgicos à penicilina, com sífilis primária ou secundária podem ser tratados com o seguinte regime posológico como alternativa à terapêutica com penicilina: doxiciclina 100 mg, por via oral, duas vezes ao dia, durante duas semanas. Sífilis latente e terciária: Os doentes alérgicos à penicilina, com sífilis secundária ou terciária podem ser tratados com o seguinte regime posológico como alternativa à terapêutica com penicilina: doxiciclina 100 mg, por via oral, duas vezes ao dia durante duas semanas, se se souber que a duração da infeção é inferior a um ano. Caso contrário, a doxiciclina deve ser administrada durante quatro semanas. Doença inflamatória pélvica aguda (DIP): Doente internado - Doxiciclina 100 mg a cada 12 horas, juntamente com cefoxitina 2 g IV a cada seis horas ou cefotetano 2 g IV a cada 12 horas durante pelo menos quatro dias e pelo menos 24 a 48 horas depois de o doente ter melhorado. Depois, prosseguir com a doxiciclina 100 mg, por via oral, duas vezes ao dia até completar 14 dias de tratamento no total. Doente ambulatório - Doxiciclina 100 mg, por via oral, duas vezes ao dia durante 14 dias como terapêutica adjuvante com ceftriaxona 250 mg IM uma vez, ou cefoxitina 2 g IM, juntamente com probenecida 1 g, por via oral, numa única dose, concomitantemente, por uma vez, ou outra cefalosporina de terceira geração (por exemplo, ceftizoxima ou cefotaxima) por via parentérica. Acne Vulgaris:
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