tetracycline (Achromycin, Sumycin, Bristacycline)
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Introduction
Tradenames: Achromycin, Sumycin.
Indications
- bacterial infections caused by susceptible bacteria, including mycoplasma & chlamydia, spirochetes, rickettsiae & some protozoa
- skin or soft tissue infection
- skin infection
- stage 1 Lyme disease
- used in combination with other agents for severe acne
- rosacea
- oral infection
- respiratory tract disease
- intra-abdominal infection
- gastrointestinal infection
- used in combination with other agents for treatment of gastritis due to H pylori
- tropical sprue
- traveler's diarrhea
- enterocolitis
- proctitis
- genitourinary infection
- rickettsia infection
- Rock Mountain spotted fever
- rickettsialpox
- endemic typhus
- scrub typus
- Brill-Zinsser disease
- Boutonneuse fever
- ehrlichiosis
- Bartonella infection
- anthrax, cutaneous anthrax, inhalation anthrax
- tularemia
- brucellosis
- listeriosis
- psitacosis
- mycobacterial infections
- plague
- plague prophylaxs
- leptospirosis
- eye disease
- acute otitis media
- malaria
- anoplura (lice)[7]
Contraindications
Dosage
- take on an empty stomach (food impairs absorption)
- 250-500 mg IV/PO QID
- maximum dose is 1 g/day with hepatic insufficiency
Tabs: 250 & 500 mg.
Suspension: 125 mg/5 mL.
Ophthalmic: 1-2 drops BID-QID PRN or ointment every 2-12 hours
Ointment: 1% (3.72 g).
Suspension: 1% (1 mL).
Dosage adjustment in renal failure
Table
| creatinine clearance | dosage |
|---|---|
| 50-80 mL/min | 8-12 hour dosing |
| 10-50 mL/min | 12-24 hour dosing |
| < 10 mL/min | 24 hour dosing |
Pharmacokinetics
- well distributed to most body tissues & fluids
- approximately 60% excreted unchanged in the urine
- hemodialysis removes 20-30%, 5-20%[6]
- peritoneal dialysis has no effect
- elimination 1/2life is 11 hours with normal renal function & 57-108 hours in anuric patients
- dose adjustment indicated for renal insufficiency
elimination via liver
elimination via kidney
Adverse effects
- common (> 10%)
- discoloration of teeth & enamel hypoplasia (infants)
- less common (1-10%)
- uncommon (< 1%)
- increased intracranial pressure, bulging fontanels in infants, paresthesia, diabetes insipidus, vomiting, erosive esophagitis, anorexia, abdominal cramps, acute renal failure, azotemia, superinfections, pericarditis, anaphylaxis, pruritus, pigmentation of nails, exfoliative dermatitis, thrombophlebitis, pseudotumor cerebri, pseudomembranous colitis, staphylococcal enteritis, hepatotoxicity, renal damage, hypersensitivity reactions, candida superinfection
- other
- phototoxicity
- tooth deposition
- 2-fold increased risk of miscarriage[8]
Drug interactions
- decreased absorption of tetracycline with:
- decreased serum concentrations of tetracyclines when coadministered with:
- tetracyclines can increase serum concentration of:
- food & dairy products interfere with absorption of tetracycline
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Laboratory
Mechanism of action
- bacteriostatic
- inhibits bacterial protein synthesis
- inhibits matrix metalloproteinases (matrixins)
More general terms
More specific terms
- chlortetracycline (Aureomycin)
- demeclocycline (Declomycin)
- doxycycline (Vibramycin, Doryx, Periostat, Oracea)
- eravacycline (Xerava)
- minocycline (Minocin, Solodyn, Emrosi)
- omadacycline; amadacycline (Nuzyra)
- oxytetracycline (Terramycin, Clinamycin)
- sarecycline (Seysara)
- Tetracycline Ophthalmic
Additional terms
Component of
- cortisol/diphenhydramine/nystatin/tetracycline
- bismuth subcitrate/metronidazole/tetracycline
- bismuth subsalicylate/metronidazole/tetracycline
- metronidazole/tetracycline
- Helidac kit (triple therapy)
- metronidazole/subsalicylate/tetracycline (Pylera)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 164
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Prescriber's Letter 6(10):58, Oct, 1999
- ↑ 6.0 6.1 Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 7.0 7.1 Deprecated Reference
- ↑ 8.0 8.1 Muanda FT, Sheehy O, Berard A Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017 May 1;189:E625-33 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28461374 <Internet> http://www.cmaj.ca/content/189/17/E625.full.pdf+html