{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:50:55Z","timestamp":1787010655751,"version":"build-2736575974"},"posted":{"date-parts":[[2023,9,23]]},"group-title":"Public and Global Health","reference-count":10,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>Doxycycline as post-exposure prophylaxis (doxy-PEP) reduces the risk of gonorrhea, chlamydia, and syphilis in studies of men who have sex with men (MSM) and transgender women (TGW) on HIV Pre-exposure Prophylaxis (PrEP) and people living with HIV (PLWH)). Doxy-PEP is an important tool to address the increasing burden of sexually transmitted infections (STIs), but there is concern that increased consumption of doxycycline may drive antimicrobial resistance. We estimated the expected increase in antibiotic use in the US under several doxy-PEP prescribing scenarios. We accounted for doses of antibiotics that may be averted due to the prevention of chlamydia, gonorrhea, and syphilis infections by doxy-PEP. Under a scenario of 75% adoption among the eligible population, with rates of consumption similar to the DoxyPEP trial population, monthly antibiotic consumption would increase by around 2.52 million doses, driven by doxy-PEP consumption of 2.58 million doses and less 62.1 thousand antibiotic doses that would otherwise have been used for chlamydia, gonorrhea, and syphilis treatment.<\/jats:p>","DOI":"10.1101\/2023.09.20.23295787","type":"posted-content","created":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T02:00:17Z","timestamp":1695520817000},"source":"Crossref","is-referenced-by-count":5,"title":["Estimating changes in antibiotic consumption with the introduction of doxycycline post-exposure prophylaxis in the United States"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3468-2014","authenticated-orcid":false,"given":"Kirstin I. Oliveira","family":"Roster","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5646-1314","authenticated-orcid":false,"given":"Yonatan H.","family":"Grad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2023092613450460000_2023.09.20.23295787v1.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2211934"},{"key":"2023092613450460000_2023.09.20.23295787v1.2","unstructured":"Molina JM , Bercot, Beatrice , Assoumou L , Michele, Algarte-Genin , Rubenstein, Emma , Pialoux, Gilles , et al. ANRS 174 DOXYVAC: AN OPEN-LABEL RANDOMIZED TRIAL TO PREVENT STIs IN MSM ON PrEP - CROI Conference. In 2023 [cited 2023 Sep 8]. Available from: https:\/\/www.croiconference.org\/abstract\/anrs-174-doxyvac-an-open-label-randomized-trial-to-prevent-stis-in-msm-on-prep\/"},{"key":"2023092613450460000_2023.09.20.23295787v1.3","unstructured":"California Department of Public Health. Doxycycline Post-Exposure Prophylaxis (doxy-PEP) for the Prevention of Bacterial Sexually Transmitted Infections (STIs). State of California Health and Human Services Agency. 2023 Apr 28;"},{"key":"2023092613450460000_2023.09.20.23295787v1.4","unstructured":"San Francisco Department of Public Health. Health Update: Doxycycline Post-Exposure Prophylaxis Reduces Incidence of Sexually Transmitted Infections. SFDPH Population Health Division. 2022 Oct 20;"},{"key":"2023092613450460000_2023.09.20.23295787v1.5","doi-asserted-by":"crossref","unstructured":"Mortimer TD , Grad YH . A Genomic Perspective on the Near-term Impact of Doxycycline Post-exposure Prophylaxis on Neisseria gonorrhoeae Antimicrobial Resistance. Clin Infect Dis. 2023 May 4;ciad279.","DOI":"10.1101\/2023.03.14.23287223"},{"issue":"8","key":"2023092613450460000_2023.09.20.23295787v1.6","doi-asserted-by":"crossref","first-page":"e268","DOI":"10.1016\/S1473-3099(23)00359-6","article-title":"Selection of Neisseria gonorrhoeae ceftriaxone resistance using doxycycline post-exposure prophylaxis","volume":"23","year":"2023","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"2023092613450460000_2023.09.20.23295787v1.7","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1093\/jac\/dkad129","article-title":"Important considerations regarding the widespread use of doxycycline chemoprophylaxis against sexually transmitted infections","volume":"78","year":"2023","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"2023092613450460000_2023.09.20.23295787v1.8","doi-asserted-by":"crossref","first-page":"dlac009","DOI":"10.1093\/jacamr\/dlac009","article-title":"A systematic review of the impacts of oral tetracycline class antibiotics on antimicrobial resistance in normal human flora","volume":"4","year":"2022","journal-title":"JAC-Antimicrob Resist"},{"key":"2023092613450460000_2023.09.20.23295787v1.9","doi-asserted-by":"crossref","unstructured":"Traeger MW , Mayer KH , Krakower DS , Gitin S , Jenness SM , Marcus JL . Potential impact of doxycycline post-exposure prophylaxis prescribing strategies on incidence of bacterial sexually transmitted infections. Clin Infect Dis Off Publ Infect Dis Soc Am. 2023 Aug 18;ciad488.","DOI":"10.1093\/cid\/ciad488"},{"key":"2023092613450460000_2023.09.20.23295787v1.10","doi-asserted-by":"crossref","unstructured":"Reichert E , Grad YH . Resistance and prevalence implications of doxycycline post-exposure prophylaxis for gonorrhea prevention in men who have sex with men: a modeling study [Internet]. medRxiv; 2023 [cited 2023 Sep 8]. p. 2023.04.24.23289033. Available from: https:\/\/www.medrxiv.org\/content\/10.1101\/2023.04.24.23289033v1","DOI":"10.1101\/2023.04.24.23289033"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2023.09.20.23295787","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T19:41:28Z","timestamp":1768506088000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2023.09.20.23295787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,23]]},"references-count":10,"URL":"https:\/\/doi.org\/10.1101\/2023.09.20.23295787","relation":{},"subject":[],"published":{"date-parts":[[2023,9,23]]},"subtype":"preprint"}}