II. Indications
- Skin disorders
- Gastrointestinal disorders
- Helicobacter Pylori (part of quadruple therapy protocol)
- Tick-borne illness
- Miscellaneous disorders
- Sexually Transmitted Disease
III. Contraindications
- Pregnancy
- Pregnancy category D
- Children under age 8 years old
- AAP now approves Doxycycline for ANY age up to 21 day duration
- Unlike Tetracycline, Doxycycline is unlikely to cause visible tooth staining
- For severe infections (e.g. Lyme Disease, Rocky Mountain Spotted Fever), Doxycycline is a first-line agent
IV. Mechanism
- Tetracyclines are bacteriostatic, semi-synthetic, broad-spectrum Naphthacene Antibiotics produced by Streptomyces species
- Tetracyclines inhibit Bacterial Protein synthesis
- Binds to Bacterial 30S ribosomal subunit of susceptible Bacteria
- Blocks aminoacyl-tRNA binding to the mRNA-ribosome complex (ribosomal A site)
- Prevents elongated peptide chains from forming from Amino Acid residues
V. Medications: Oral and Topical Agents
-
Tetracycline
- See Tetracycline
- Acne Vulgaris: 1 gram orally daily given in 2-4 divided doses
-
Doxycycline
- See Doxycycline
- Typical dose: 100 mg orally twice daily
- Low doses, such as 50 mg daily, are often as effective for acne
- Avoid substituting low-dose Doxycycline (Periostat, Oracea) products for systemic infections
-
Minocycline (Minocin)
- Oral
- Acne Vulgaris: 50-200 mg/d orally in divided doses
- Topicals
- Acne Vulgaris: Minocycline 4% Foam (Amzeeq)
- Rosacea: Minocycline 1.5% Foam (Zilxi)
- Very expensive (nearly $500 for 30 grams)
- No evidence of benefit over other Rosacea topicals
- (2021) Presc Lett 28(6): 36 [PubMed]
- Oral
VI. Medications: Intravenous
- Eravacycline (Xerava)
-
Omadacycline (Nuzyra)
- Load: 200 mg IV for one dose (or divided 100 mg IV every 12 hours for 2 doses)
- Maintenance: 100 mg IV once daily (or 300 mg orally once daily)
- Once daily agent indicated for Community Acquired Pneumonia and Skin Infections
- Released in 2018 at $400 per pill, and likely less effective than standard agents for CAP
- (2019) presc lett 26(1):4
VII. Drug Interactions
- Food Related
- Tetracycline
- Milk and Calcium-rich food decrease absorption
- Take 1 hour before or 2 hours after a meal
- Doxycycline and Minocycline
- Can be taken with milk or food (unlike Tetracycline)
- Take with a full glass of water
- Risk of Pill Esophagitis
- Tetracycline
-
Warfarin
- Increases INR
VIII. Precautions
- Use Sunscreen with these agents due to Drug-induced Photosensitivity
-
Pill Esophagitis
- Take with a full glass of water
IX. Adverse Effects
- General
-
Tetracycline
- Photosensitivity
- Interferes with OCP action
-
Tooth Discoloration (Children under age 8 years)
- Tooth enamel hypoplasia
- Rare with Doxycycline
-
Doxycycline
- Photosensitivity
- Abdominal Pain
- Diarrhea
- Pill Esophagitis (see above)
-
Minocycline
- Generally well tolerated
- Does not generally cause photosensitivity
-
Minocycline-Induced Hyperpigmentation
- Blue-gray or muddy brown Hyperpigmentation resulting from Minocycline-iron complex skin deposition
- Distribution: Face, arms, legs (esp. shins)
- Highest risk in long-term dosing for chronic infection or Rheumatoid Arthritis (risk increases with longer duration)
- Uncommon with low dose Acne Vulgaris use
- Hyperpigmentation often persists even after Minocycline is discontinued (limited therapies, e.g. laser)
- Jain (2019) Am Fam Physician 100(4): 239-240 [PubMed]
- Rare adverse effects
- Lupus-Like Syndrome (1:20,000)
- Vertigo
- Oral Mucosa pigmentation (blue-black pigmentation)
- Hypersensitivity Syndrome within 1-3 months
- Delayed Arthralgias or Polyarthritis
- Omadacycline (Nuzyra)
X. References
- (2019) Tarascon Pharmacopeia, accessed 3/31/2019
- LoVecchio (2019) Crit Dec Emerg Med 33(3): 28
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Definition (MSH) | Polyacenes with four ortho-fused benzene rings in a straight linear arrangement. This group is best known for the subclass called TETRACYCLINES. |
Concepts | Organic Chemical (T109) |
MSH | D009279 |
English | Naphthacenes, Naphthacenes [Chemical/Ingredient], Tetracenes, Benz(b)Anthracenes |
Swedish | Naftasener |
Czech | naftaceny |
Finnish | Naftaseenit |
Russian | NAFTATSENY, НАФТАЦЕНЫ |
Japanese | ナフタセン, ナフタセン誘導体 |
Croatian | Not Translated[Naphthacenes] |
Polish | Naftacenu pochodne |
French | Tétracènes, Naphtacènes |
Norwegian | Not Translated[Naphthacenes] |
German | Naphthacene |
Italian | Naftaceni |
Portuguese | Naftacenos, Tetracenos |
Spanish | Naftacenos, Tetracenos |
Ontology: Tetracycline Antibiotics (C1744619)
Definition (CHV) | a kind of antibiotics |
Definition (CHV) | a kind of antibiotics |
Definition (NCI) | Any of a group of broad spectrum naphthacene antibiotics isolated from various species of Streptomyces or produced semisynthetically. In bacteria, tetracycline antibiotics block binding of aminoacyl-tRNA to the mRNA-ribosome complex, thereby inhibiting protein synthesis. (NCI05) |
Definition (CSP) | group of napthacenecarboxamide biosynthetic antibiotics isolated from species of Streptomyces or produced semisynthetically, with a wide spectrum of antimicrobial activity. |
Definition (PDQ) | Any of a group of broad spectrum naphthacene antibiotics isolated from various species of Streptomyces or produced semisynthetically. In bacteria, tetracycline antibiotics block binding of aminoacyl-tRNA to the mRNA-ribosome complex, thereby inhibiting protein synthesis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=470241&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=470241&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1595" NCI Thesaurus) |
Concepts | Chemical Viewed Functionally (T120) |
SnomedCT | 324009002, 354048000, 105910009, 332316001, 373206009, 282831004 |
English | Tetracyclines [skin], Tetracyclines [systemic], tetracycline antibiotic, Tetracycline Antibiotics, tetracyclines (medication), tetracyclines, Tetracycline drug, [AM250] TETRACYCLINES, tetracycline, TETRACYCLINES, Tetracycline antibiotics, Tetracyclines [systemic] (product), Tetracycline (class of antibiotic, substance) (product), Tetracyclines (substance), Tetracyclines [skin] (product), Tetracycline (class of antibiotic), Tetracycline (class of antibiotic, substance) (substance), Tetracyclines, Tetracyclines (product), Tetracyclines [skin] (substance), Tetracyclines [systemic] (substance), Tetracycline Antibiotic |
Spanish | tetraciclinas, tetraciclina (uso dermatológico), tetraciclina (clase de antibiótico), tetraciclina (clase de antibiótico) (clase de antibiótico, sustancia) (producto), tetraciclina [uso sistémico], tetraciclina [uso sistémico] (producto), tetraciclinas (sustancia), tetraciclina (uso dermatológico) (producto), tetraciclina (clase de antibiótico) (clase de antibiótico, sustancia) (sustancia), tetraciclina (clase de antibiótico, sustancia) (sustancia), tetraciclina (clase de antibiótico, sustancia), tetraciclinas (piel) (producto), tetraciclinas (piel), tetraciclinas [sistémicas] (producto), tetraciclinas [sistémicas], teraciclinas (producto), teraciclinas |