Talk:Doxycycline

GA Review

This review is transcluded from Talk:Doxycycline/GA1. The edit link for this section can be used to add comments to the review.

Nominator: Maxim Masiutin (talk · contribs) 21:28, 23 December 2024 (UTC)

Reviewer: Toadspike (talk · contribs) 20:45, 16 January 2025 (UTC)

GA review – see WP:WIAGA for criteria

1. Is it well written?

   A. The prose is clear and concise, and the spelling and grammar are correct:

   B. It complies with the manual of style guidelines for lead sections, layout, words to watch, fiction, and list incorporation:

2. Is it verifiable with no original research, as shown by a source spot-check?

   A. It contains a list of all references (sources of information), presented in accordance with the layout style guideline:

   B. Reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose):

   C. It contains no original research:

   D. It contains no copyright violations nor plagiarism:

3. Is it broad in its coverage?

   A. It addresses the main aspects of the topic:

   B. It stays focused on the topic without going into unnecessary detail (see summary style):

4. Is it neutral?

   It represents viewpoints fairly and without editorial bias, giving due weight to each:

5. Is it stable?

   It does not change significantly from day to day because of an ongoing edit war or content dispute:

6. Is it illustrated, if possible, by images?

   A. Images are tagged with their copyright status, and valid non-free use rationales are provided for non-free content:

   B. Images are relevant to the topic, and have suitable captions:

7. Overall:

   Pass or Fail:

Comments

(Disclaimer: If you disagree with me, just let me know. Not all of my suggestions are required to meet the GA criteria.)

• Many more wikilinks are needed, especially on technical terms. On the other hand, some links are repeated several times, which is unnecessary unless they are very far apart.
• Many sources need to replaced to comply with WP:MEDRS.
  • A lot of sources are very old; WP:MEDDATE recommend that reviews not be older than five years old. I am willing to give significant leeway on this, especially on books, but as a rule of thumb all sources from before 2000 (twenty-five years ago) must be replaced, and it would be preferable if all sources from before 2010 (fifteen years ago) were replaced. Cited guidelines, especially, should be as up-to-date as possible.
  • Several sources also look like primary sources, which should be replaced by citations to reviews. If the same information is not mentioned in a review, it should be removed.

Images

• Perhaps the caption "Tet-ON inducible shRNA system" could be made a little more comprehensible by indicating the significance of the system.
• For an article of this length, more images wouldn't hurt. Perhaps images of the bacteria or diseases doxycycline is used against, or more diagrams in the Pharmacology or Chemistry sections.

Lead

• "Like other agents of the tetracycline class, it either slows or kills bacteria by inhibiting protein production" – I would remove the word "either" here, since I believe both can be true. Also, linking protein production would be a good idea.
• "In 2022, it was the 68th most commonly prescribed medication in the United States, with more than 9 million prescriptions." Numbers for the whole world, if available, would very useful as well.
• Doxycycline as PEP should be mentioned in the lead. I also think the abbreviation "DoxyPEP" should be mentioned somewhere.
• The lead mentions use during pregnancy. Use in children should be mentioned, too.

Infobox

• Pronunciation respelling: I think it should be "DOKS-ih-SYE-kleen", with the "s" sound in the third syllable, not the second.
• Perhaps there are other trade names out there, not sure if it's worth listing more.
• Legal status: It would be interesting to expand this to include other large countries, like Germany, China, Japan, or Brazil. On the other hand, if a prescription is required everywhere, this could be condensed to say "Prescription only in countries A, B, C, D, and E" instead of listing the exact abbreviation each country uses.

Medical uses

• "in addition to the general indications for all members of the tetracycline antibiotics group" – list them.
• "In Canada, in 2004..." – is this relevant? Why include one example from one country from 20 years ago?
• "anti-angiogenic" needs a link.
• "It is effective against bacteria such as..." – it might be good to mention what diseases these bacteria cause, to emphasize their relevance. The first two seem not to be associated with a disease, but the third (pneumonia) and fourth (mycoplasma pneumonia) are.
• "anthrax, leptospirosis, bubonic plague" need wikilinks for each.
• I would adjust the following sentence for better flow: "However, some bacteria have shown resistance to doxycycline, including Haemophilus spp., Mycoplasma hominis, and Pseudomonas aeruginosa." This way the reader knows from the beginning what the sentence is about. By the way, what does "spp." mean?
• The sentence after that, "It is also effective against Yersinia...", duplicates some information that was already mentioned earlier in the section. I would add Yersinia pestis to the list of bacteria earlier in the paragraph, and remove bubonic plague and Lyme disease from this sentence.
• The first bulleted list is slightly overlinked: several items are linked earlier in the article, some in the previous paragraph (like Rocky Mountain spotted fever).
• On the other hand, respiratory tract infections should be linked, as should "urethral, endocervical, and rectal".
• Depending on what happens to Y. pestis in the previous paragraph, the link here can be removed.
• The section headings for the Gram-positive and -negative bacteria are a mess in terms of hyphenation (not your fault). I am told that the correct hyphenation would be "Gram-negative bacteria-specific indications", but I would suggest rewording both section headings to "Indications for Gram-negative bacteria" or simply "Gram-negative bacteria".
• "bacteriologic testing" could do with a short explanation, perhaps specifying what kind of testing, and perhaps a link to Bacteriology. I am also not sure if "When bacteriologic testing indicates appropriate susceptibility" means that every single patient's bacteria must be tested before use, which seems like a huge pain.
• I am not sure if the former names of bacteria are required, unless you still find sources using/mentioning them. For an added twist, Klebsiella aerogenes says that "Enterobacter aerogenes" is itself a former name; this should be updated.
• Antibiotic resistance: "Up to 44%..." – where are these statistics from? As far as I know, antibiotic resistance varies heavily by geographical region, which would be relevant context for these statistics.
• I think adding the abbreviation MRSA in parentheses after "methicillin-resistant Staphylococcus aureus" might be a good idea, since there's a good chance laypeople have only heard of/seen the acronym and not the full name.
• Penicillin should be linked. Perhaps specify some reasons why it would be contraindicated. Also since many people who think they have a "penicillin allergy" are not actually allergic, that could be mentioned here if you like.
• The "Use as adjunctive therapy" section has three one-sentence paragraphs. Combining them into a larger one or expanding them with more content would be good.
• Link post-exposure prophylaxis when first mentioned.
• I think the comma between "in particular" and "in Neisseria gonorrhoeae" is unnecessary.
• Could GBMSM be shortened to just MSM? This longer acronym is redundant, and I believe it's uncommon as well.
• The "Australian consensus" part puts too much weight on one country – a more thorough overview of doxyPEP is needed, probably including the landmark San Francisco study and gov't recommendation [1].
• "Appropriate use" is vague. If further details are unnecessary, then simply remove the word "appropriate" and start the sentence with "use".
• "Australasian Society for HIV Medicine" could be a redlink, they are likely notable.
• Explain the connection between P. falciparum and malaria in the "Antimalarial" section. Currently it is only implied that the two are related. You later say "the parasite", with the implication that "the parasite" is P. falciparum, but this should be explicitly stated.
• "Gametocytes" should be linked.
• "antimalarial effect of doxycycline is delayed" – do you have any numbers for this? How long is it delayed? Compared to what (other medications)?
• "in apicoplast" is ungrammatical. It should probably be "in the apicoplasts", but that makes the singular "(an organelle)" afterwards a little awkward. My ideas to solve this are to 1. remove the parenthetical or 2. change it to "(a kind of organelle)".
• I would replace "—such blocking" with ". This blocking" (break into two sentences).
• Link "fatty acids", "heme", and "cofactor" (to Cofactor (biochemistry)). Perhaps also briefly explain what a cofactor is.
• Explain the "blood stage". Whose blood? I assume human blood? Mosquitos also have blood, right?
• "multiplication" is okay, but perhaps a less ambiguous word like "reproduction" is better. Up to you, though.
• The next sentence needs a comma before "but".
• The "Antihelminthic" section never once uses the word "helminth". I suggest changing the section header to "Antiparasitic", though perhaps that also applies to the malaria stuff...alternatively you can mention helminths in the prose and explain briefly what they are (parasites).
• Artesunate and quinine should be linked.
• "uncomplicated" and "severe" malaria could do with an explanation, but this isn't necessary.
• "Field trials in 2005" – unless these trials are still widely cited in reviews, this needs an update.
• The "Spectrum of susceptibility" section repeats a lot of information that has already been given elsewhere, unclear if this section is needed.
• "ophthalmic" should be linked, probably to Ophthalmology or Eye. Apparently we don't have an article on eye infections more broadly.
• "microorganisms" before the bulleted list should be followed by a colon, not a period.
• mu in micrograms doesn't need to be italicized.
• "slow-flow vascular malformations" – I'm pretty sure I know what this means, but the average reader would have no clue. There should be a link to Vascular malformation and some kind of explanation.
• A parenthetical after "lymphocele" like "(collection of lymph fluid outside of lymphatic vessels)" might be helpful.

Off-label use

• This section is really short. It could be merged as a subsection of the "Medical uses" section.
• Off-label use should be linked.
• "Promising" is weird here, especially since the same sentence says it is "capable". So...is it only "promising" or do we know that it works? The source for this is a primary paper from 2020, maybe you could find a review that covers off-label use of doxycyclin, and maybe more recent research has been done that resolves the "promising" question.

Routes of administration

• The first sentence could be condensed to "Doxycycline can be administered orally or intravenously." Also, the one-sentence paragraph looks weird. Is there anything more to be said about this?
• "dairy, antacids, calcium supplements, iron products, laxatives containing magnesium" many of these items should be linked.
• The discussion of absorption is fairly contradictory. First, it lists several items that may decrease absorption. Then, it says "Unlike other tetracyclines, its absorption is not significantly affected by food or dairy intake". Then, it says that certain cations do inhibit absorption. I am baffled.
• "Proximal small intestine" – this made me wonder which parts of the small intestine (duodenum/jejunum/ileum), so I checked the source (which is somewhat old), which actually says "Doxycycline is almost completely absorbed following oral administration in the stomach and proximal small bowel". The stomach should be mentioned, and if the details of which parts of the small intestine can be found in another (preferably newer) source that'd be awesome.
• Divalent and trivalent cations: Since this is a concept that can be understood by high schoolers, it should be explained in a way that they would understand. I suggest something like "Cations with a 2+ or 3+ charge", including the link.
• Link "bismuth", "complexes", "gastric" (except that a mention will be added earlier in this paragraph), and "duodenum".

Contraindications

• Replace "concomitant" with a simpler word, like "simultaneous".
• The first sentence does not have a subject. The word "Doxycycline" needs to appear near the start of each section, which I believe (incomplete sentences aside) should be able to stand alone in terms of meaning.
• After the first use of "contraindications" (which should be linked), perhaps add an explanation like ", which means that doxycycline should not be used,"
• Are liver disease and retinoids contraindications for tetracyclines broadly or only doxycycline?
• "increased pressure" – of what? (blood pressure, which should be linked).
• What does it mean that doxycycline is a "class D drug"?
• "Other tetracycline antibiotics are contraindicated in pregnancy and up to eight years of age, due to the potential for disrupting bone and tooth development" – When I checked the WHO source for the list of essential medicines [2], it says on page 53 (PDF page 58) that doxycycline is restricted to ">8 years (except for serious infections e.g. cholera)". Perhaps this is worth mentioning here. It would be best if this section could focus on doxycycline specifically, since that information appears to exist.
• "They include a class warning" – who is "they"? The FDA? Is the contraindication in the previous sentence also from the FDA? Does the "class warning" mean it applies to all tetracyclines? This all needs to be clarified, as it may vary heavily between countries and also the WHO.
• "staining of teeth" should link to Tooth discoloration. It should also be explained what color they are stained (if you can find this info) and if this is really a bad thing or just cosmetic.
• link "dental enamel", italicize and link "in utero", link "breastfeeding"
• Can "young childhood" be quantified (specific age range)
• "primary teeth" should be linked, and perhaps add "(baby teeth)" afterwards.
• "hypoplasia" should be linked and perhaps add "(underdevelopment)" afterwards.
• I have fixed the run-on sentence at the end of this section. "young children" should again be quantified (in parentheses is fine) and the "others" in "others advocate for its use in malaria" should be specified.

Adverse effects

• The first sentence of this section is incomplete. It needs the words "of doxycycline" after "Adverse effects", otherwise it has no subject.
• I was gonna suggest that you link "gastrointestinal upset", but that redirect isn't very helpful. On the other hand, Pill esophagitis is a decent link to add.
• Is it possible to clarify what kind of mobility "impaired mobility" refers to? That normally means someone who, for example, needs a wheelchair; I am not sure if that would affect swallowing/digestion. Perhaps "motility" (in the digestive sense) is meant instead.
• "erythematous" should be replaced or explained in parentheses "(redness)". That word is meaningless to the average person, even though they have probably seen/experienced it.
• "all skin events" enumerated: which skin events? Please list some examples. That paragraph is cited to a review paper, which cites this study (TWL link) for that part, so it shouldn't be too hard to clarify. Also, the phrasing "did not cause a significantly higher percentage of all skin events" makes like it sounds like it caused a significantly higher percentage of some skin events (scary!) – perhaps this could be reworded to be less ambiguous.
• The last sentence of this paragraph, "The rash resolves...", seems to follow up on the first sentence, "An erythematous rash...". I think the last sentence should thus be moved to right after the first sentence, before the discussion of that study.
• Another one-sentence paragraph ("Unlike some other members..."): Either expand or merge.

Interactions

• This section is fairly short and I don't see why it couldn't be merged to fall under the "Contraindications" section or the "Pharmacology" section. Preferably the former.
• Barrier contraception should be linked.
• CYP450 should be explained "(enzyme)" and it should also be explained how CYP450 induction impairs the effectiveness of contraception. For simplicity, maybe also replace "induction" with "activation".

Pharmacology

(Around this point I've started adding wikilinks myself to lighten your workload. I will probably go back and fix all the earlier wikilink issues myself as well, since this is an uncontroversial task.)

• The second paragraph of this section contains a lot of information repeated in the "Pharmacokinetics" section. I think one should be merged into the other, no preference which, but this is not a hard requirement.
• "Doxycycline is highly lipophilic, so it can easily enter cells, meaning the drug is easily absorbed after oral administration..." – Wouldn't this also apply to an IV though? I think the word "oral" should be removed here.
• "Volume of distribution" should be explained. This will probably take a full sentence.
• Does "compensatory excretion" mean that if the patient has kidney failure, they will excrete more of the doxycycline than usual via the feces? I think this can be written in a way that makes the causality clear to laypeople, rather than implying there's some regulatory mechanism to complex to explain. Also, since the article seems to be written in US English, "feces" should be spelled without an "a".
• "at acidic pH" – I think grammatically this should be "at acidic pHs" (plural), but that looks bad. I suggest rewording to "in acidic conditions". Acid should probably be linked.
• "earlier tetracycline compounds" – I assume this means compounds that were discovered before doxycycline, but it's ambiguous, since it could also mean tetracyclines a hypothetical patient took before doxycycline. I recommend replacing "earlier" with "older" or "other", but if you can be specific about which tetracyclines are meant, that would be even better.
• "earlier drugs" in the next sentence – same deal.
• "time to kill and remove the bacteria" – not sure if both "kill" and "remove" are needed, I suggest removing "and remove". As far as I know, the "removal" is usually done simultaneously as part of the killing (phagocytosis), or is not really a priority (complement system).
• The section header "Pharmacokinetics" is...okay. However, I suggest it be renamed as "Absorption and excretion", since that is what it covers, and a layperson would understand both of those words.
• "upper part of the small intestine" – I mentioned earlier that the stomach might also be involved and it would be nice if you could specify which part(s) of the small intestine specifically.
• I would add "(breakdown)" after "Doxycycline metabolism" at the start of the next paragraph.

Discussion

Maxim Masiutin, although I haven't finished writing up the review, I'm pinging you so that you can get started. Sources being too old or primary is the largest issue I have identified. Toadspike [Talk] 09:47, 18 January 2025 (UTC)

@Toadspike I can find newer and nonprimary sources Maxim Masiutin (talk) 10:09, 18 January 2025 (UTC)