III. Contraindications

  1. Pregnancy
    1. Pregnancy category D
  2. Children under age 8 years old
    1. AAP now approves Doxycycline for ANY age up to 21 day duration
    2. Unlike Tetracycline, Doxycycline is unlikely to cause visible tooth staining
    3. For severe infections (e.g. Lyme Disease, Rocky Mountain Spotted Fever), Doxycycline is a first-line agent

IV. Mechanism

  1. Tetracyclines are protein synthesis inhibitors, binding the 30S ribosomal subunit of susceptible Bacteria

V. Preparations

  1. Tetracycline
  2. Minocycline
  3. Nuzyra (Omadacycline)
    1. Once daily agent indicated for Community Acquired Pneumonia and Skin Infections
    2. Released in 2018 at $400 per pill, and likely less effective than standard agents for CAP
    3. (2019) presc lett 26(1):4
  4. Doxycycline
    1. Avoid substituting low-dose Doxycycline (Periostat, Oracea) products for systemic infections
    2. May substitute other Doxycycline salts
      1. Doxycycline hyclate (Vibramycin, Doryx)
      2. Doxycycline monohydrate (Monodox)
      3. (2013) Presc Lett 20(5):26
    3. Other formulations
      1. Doxycyline Hyclate Delayed-Release (Doryx MPC)
        1. Expensive ($10/pill) formulated to by-pass the esophagus for less side effects
        2. Alternatively, take the doxycyline with 8 oz water and food
        3. (2016) Presc Lett 23(11)

VI. Dosing: Tetracycline

  1. Acne Vulgaris: 1 gram daily given in 2-4 divided doses

VII. Dosing: Doxycyline

  1. Typical dose: 100 mg orally twice daily
  2. Low doses, such as 50 mg daily, are often as effective for acne

VIII. Dosing: Minocycline

  1. Acne Vulgaris: 50-200 mg/d in divided doses

IX. Dosing: Omadacycline (Nuzyra)

  1. Load: 200 mg IV for one dose (or divided 100 mg IV every 12 hours for 2 doses)
  2. Maintenance: 100 mg IV once daily (or 300 mg orally once daily)

X. Drug Interactions: Food Related

  1. Tetracycline
    1. Milk and calcium-rich food decrease absorption
    2. Take 1 hour before or 2 hours after a meal
  2. Doxycycline and Minocycline
    1. Can be taken with milk or food (unlike Tetracycline)

XI. Precautions

  1. Use Sunscreen with these agents due to Drug-induced Photosensitivity
  2. Pill Esophagitis
    1. Take with a full glass of water

XII. Adverse Effects

  1. Tetracycline
    1. Photosensitivity
    2. Interferes with OCP action
  2. Doxycycline
    1. Photosensitivity
    2. Abdominal Pain
    3. Diarrhea
    4. Pill Esophagitis (see above)
  3. Minocycline
    1. Generally well tolerated
    2. Does not generally cause photosensitivity
    3. Rare adverse effects
      1. Lupus-like syndrome (1:20,000)
      2. Vertigo
      3. Oral Mucosa pigmentation (blue-black pigmentation)
      4. Hypersensitivity Syndrome within 1-3 months
      5. Delayed Arthralgias or Polyarthritis
  4. Omadacycline
    1. Nausea and Vomiting are most common (>10% of patients)

XIII. References

  1. (2019) Tarascon Pharmacopeia, accessed 3/31/2019
  2. LoVecchio (2019) Crit Dec Emerg Med 33(3): 28

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Cost: Medications

tetracycline (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
TETRACYCLINE 250 MG CAPSULE Generic $5.23 each
TETRACYCLINE 500 MG CAPSULE Generic $7.81 each
doxycycline (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
DOXYCYCLINE 25 MG/5 ML SUSP Generic $0.29 per ml
DOXYCYCLINE HYC DR 100 MG TAB Generic $8.83 each
DOXYCYCLINE HYCLATE 100 MG CAP Generic $0.49 each
DOXYCYCLINE HYCLATE 100 MG TAB Generic $0.63 each
DOXYCYCLINE HYCLATE 20 MG TAB Generic $0.36 each
DOXYCYCLINE HYCLATE 50 MG CAP Generic $0.59 each
DOXYCYCLINE IR-DR 40 MG CAP Generic $15.88 each
DOXYCYCLINE MONO 100 MG CAP Generic $0.42 each
DOXYCYCLINE MONO 100 MG TABLET Generic $0.50 each
DOXYCYCLINE MONO 150 MG TABLET Generic $5.36 each
DOXYCYCLINE MONO 50 MG CAP Generic $0.31 each
DOXYCYCLINE MONO 50 MG TABLET Generic $0.44 each
minocycline (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
MINOCYCLINE 100 MG CAPSULE Generic $0.35 each
MINOCYCLINE 50 MG CAPSULE Generic $0.21 each
MINOCYCLINE 75 MG CAPSULE Generic $0.44 each
MINOCYCLINE HCL 100 MG TABLET Generic $2.82 each
MINOCYCLINE HCL 50 MG TABLET Generic $1.29 each

Ontology: Doxycycline (C0013090)

Definition (CHV) a kind of antibiotics
Definition (MSH) A synthetic tetracycline derivative with similar antimicrobial activity.
Definition (NCI_NCI-GLOSS) A drug used to treat many types of bacterial infections. It stops the growth of bacteria by keeping them from making proteins. It is a type of antibiotic.
Definition (NCI) A synthetic, broad-spectrum tetracycline antibiotic exhibiting antimicrobial activity. Doxycycline binds to the 30S ribosomal subunit, possibly to the 50S ribosomal subunit as well, thereby blocking the binding of aminoacyl-tRNA to the mRNA-ribosome complex. This leads to an inhibition of protein synthesis. In addition, this agent has exhibited inhibition of collagenase activity.
Definition (PDQ) A synthetic, broad-spectrum tetracycline antibiotic exhibiting antimicrobial activity. Doxycycline binds to the 30S ribosomal subunit, possibly to the 50S ribosomal subunit as well, thereby blocking the binding of aminoacyl-tRNA to the mRNA-ribosome complex. This leads to an inhibition of protein synthesis. In addition, this agent has exhibited inhibition of collagenase activity. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42494&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42494&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C457" NCI Thesaurus)
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D004318
SnomedCT 10504007, 372478003
LNC LP14992-9, MTHU002295
English Doxycycline, 2-Naphthacenecarboxamide, 4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-, (4S-(4alpha,4aalpha,5alpha,5aalpha,6alpha,12aalpha))-, doxycycline, DOXYCYCLINE, Doxycycline [Chemical/Ingredient], Alpha 6 Deoxyoxytetracycline, Alpha-6-Deoxyoxytetracycline, Doxycycline (product), Doxycycline (substance)
Swedish Doxycyklin
Czech doxycyklin
Finnish Doksisykliini
Russian VIBRAMITSIN, DOKSITSIKLIN, ВИБРАМИЦИН, ДОКСИЦИКЛИН
Italian alfa-6-Deossi-ossitetraciclina, Doxiciclina
Croatian DOKSICIKLIN
Polish Doksycyklina, Wibramycyna
Japanese ドキシサイクリン, 塩酸ドキシサイクリン
Norwegian Doksycyklin
Spanish doxiciclina (producto), doxiciclina (sustancia), doxiciclina, Doxiciclina
French Doxycycline
German Doxycyclin
Portuguese Doxiciclina

Ontology: Minocycline (C0026187)

Definition (CHV) a kind of antibiotics
Definition (MSH) A TETRACYCLINE analog, having a 7-dimethylamino and lacking the 5 methyl and hydroxyl groups, which is effective against tetracycline-resistant STAPHYLOCOCCUS infections.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D008911
SnomedCT 13512003, 372653009
LNC LP16031-4, MTHU008456
English Minocycline, 2-Naphthacenecarboxamide, 4,7-bis(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12a-tetrahydroxy-1,11-dioxo-, (4S-(4alpha,4aalpha,5aalpha,12aalpha))-, Minocycline [Chemical/Ingredient], (2E,4S,4aR,5aS,12aR)- 2-(amino-hydroxy-methylidene)- 4,7-bis(dimethylamino)-10,11,12a-trihydroxy-4a,5,5a,6- tetrahydro-4H-tetracene- 1,3,12-trione, MINOCYCLINE, antibacterial minocycline, minocycline (medication), minocycline, Minocycline (product), Minocycline (substance)
Swedish Minocyklin
Czech minocyklin
Finnish Minosykliini
Russian MINOTSIKLIN, МИНОЦИКЛИН
Japanese ミノサイクリン塩酸塩, 塩酸ミノサイクリン, ミノサイクリン
Polish Minocyklina
Norwegian Minocyklin
Spanish minociclina (producto), minociclina (sustancia), minociclina, Minociclina
French Minocycline
German Minocyclin
Italian Minociclina
Portuguese Minociclina

Ontology: Tetracycline (C0039644)

Definition (NCI) A broad-spectrum naphthacene antibiotic produced semisynthetically from chlortetracycline, an antibiotic isolated from the bacterium Streptomyces aureofaciens. In bacteria, tetracycline binds to the 30S ribosomal subunit, interferes with the binding of aminoacyl-tRNA to the mRNA-ribosome complex, thereby inhibiting protein synthesis.
Definition (NCI_NCI-GLOSS) A drug used to treat bacterial infections. It stops the growth of bacteria by keeping them from making proteins. Tetracycline also binds to new bone tissue and is being studied as a way to detect bone growth. Tetracycline is a type of antibiotic and a type of bone-labeling agent.
Definition (MSH) A naphthacene antibiotic that inhibits AMINO ACYL TRNA binding during protein synthesis.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D013752
SnomedCT 324010007, 372809001, 66261008
LNC LP16286-4, MTHU008490
English Tetracycline, 2-Naphthacenecarboxamide, 4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,6,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-, (4S-(4alpha,4aalpha,5aalpha,6beta,12aalpha))-, Tetracycline [systemic], 4-(Dimethylamino)-1,4,4A,5,5A,6,11,12A-Octahydro-3,6,10,12,12A-Pentahydroxy-6-Methyl-1,11-Dioxo-2-Naphthacenecarboxamide, tetracycline (medication), Tetracycline [Chemical/Ingredient], TETRACYCLINE, Tetracycline [systemic] (product), tetracycline, Tetracycline (product), Tetracycline (substance), TETRA, Tetracycline, NOS, Tetracycline [systemic] (substance), TCN
German Tetrazyklin, Tetracyclin
Swedish Tetracyklin
Czech tetracyklin
Finnish Tetrasykliini
Russian TETRATSIKLIN, ТЕТРАЦИКЛИН
Japanese 塩酸テトラサイクリン, コサテトラシン, テトラサイクリン塩酸塩, アクロマイシン, テトラサイクリン
Polish Tetracyklina
Norwegian Tetracyklin
Spanish tetraciclina [sistémica], tetraciclina [sistémica] (producto), tetraciclina (producto), tetraciclina (sustancia), tetraciclina, Tetraciclina
French Tétracycline
Italian Tetraciclina
Portuguese Tetraciclina