Doxycycline vs. Cephalexin
See how Doxycycline and Cephalexin compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Doxycycline covers a broader range of infections, including tick-borne illness and sexually transmitted infections, while cephalexin mainly treats skin, respiratory, ear, bone, and urinary infections.
Cephalexin is typically taken two to four times a day, while doxycycline is usually taken once or twice daily.
Doxycycline causes sun sensitivity and isn't safe for young children or during pregnancy, while cephalexin carries a cross-reaction risk for people with penicillin allergies.
Doxycycline vs. Cephalexin Drug Summary
Doxycycline
Doxycycline is a tetracycline-class antibacterial used to treat a wide range of bacterial and rickettsial infections, including respiratory infections, sexually transmitted infections, and tick-borne illnesses. It comes as an oral capsule, tablet, or suspension, usually taken once or twice a day.
Cephalexin
Cephalexin is a first-generation cephalosporin antibacterial used to treat common bacterial infections of the skin, respiratory tract, ears, bones, and urinary tract. It comes as an oral capsule, tablet, or suspension, typically taken two to four times a day.
Doxycycline vs. Cephalexin Side Effects
Doxycycline
Cephalexin
Doxycycline vs. Cephalexin Dosage
Doxycycline
Cephalexin
| STAGE | DOSE | WHEN |
| Starting dose | 200 mg total | Day 1 |
| Maximum dose | 100 mg twice daily | If needed |
| Dose changes | 3 increases | Every day |
| STAGE | DOSE | WHEN |
| Starting dose | 25-50 mg/kg/day divided | At the start |
| Maximum dose | 1 to 4 g/day divided | If needed |
| Dose changes | 4 increases | As tolerated |
Doxycycline
| STAGE | DOSE | WHEN |
| Starting dose | 200 mg total | Day 1 |
| Maximum dose | 100 mg twice daily | If needed |
| Dose changes | 3 increases | Every day |
Cephalexin
| STAGE | DOSE | WHEN |
| Starting dose | 25-50 mg/kg/day divided | At the start |
| Maximum dose | 1 to 4 g/day divided | If needed |
| Dose changes | 4 increases | As tolerated |
Doxycycline vs. Cephalexin Indications
Doxycycline
Doxycycline treats a wide range of bacterial infections, including tick-borne illnesses like Rocky Mountain spotted fever, sexually transmitted infections, and respiratory infections. It's also FDA-approved for anthrax exposure and malaria prevention, and used off-label for Lyme disease and acne.
Rocky Mountain spotted fever and other rickettsial infections
Sexually transmitted infections including chlamydia and gonorrhea
Respiratory tract infections
Anthrax post-exposure prophylaxis
Malaria prevention
Cephalexin
Cephalexin treats common bacterial infections including strep throat, ear infections, skin infections, and urinary tract infections. It's also approved for certain bone infections and used off-label for acne, but covers a narrower range of infection types than doxycycline.
Respiratory tract infections (strep throat)
Ear infections (otitis media)
Skin and skin structure infections
Bone infections
Urinary tract and prostate infections
Doxycycline vs. Cephalexin Pros and Cons
Doxycycline
Doxycycline covers more infection types than cephalexin, including atypical bacteria that cause tick-borne illness, chlamydia, and traveler's diarrhea. It's usually dosed once or twice daily, but it requires sun protection and isn't safe for young children or during pregnancy.
Pros
Effective against atypical bacteria like rickettsia and chlamydia
Also approved for malaria prevention and anthrax exposure
Once or twice daily dosing is easier to stick with
Long-standing generic with wide availability
Cons
Causes photosensitivity, requiring sun avoidance
Not safe for children under 8 or during pregnancy
Can cause esophageal irritation if not taken with fluids
Boxed warnings for tooth discoloration and fetal harm
Cephalexin
Cephalexin is a reliable first choice for common skin, respiratory, ear, and urinary infections caused by susceptible strep and staph bacteria. It's considered safe in pregnancy and young children, but it must be taken more often and doesn't work against atypical bacteria.
Pros
Considered safe during pregnancy and in young children
No sun sensitivity or tooth discoloration concerns
Well-established for skin, ear, and urinary infections
Widely available as an inexpensive generic
Cons
Must be taken up to four times daily
Not effective against atypical bacteria like chlamydia or rickettsia
Cross-reactivity risk in people with penicillin allergy
Requires dose adjustment in kidney impairment
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