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tetracycline (Achromycin, Sumycin, Bristacycline)

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 - periodontitis - gingivostomatitis - respiratory tract disease - pharyngitis - sinusitis - bronchitis - pneumonia - intra-abdominal infection - cholangitis - 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 - treatment of non gonococcal urethritis caused by Chlamydia trachomatis & Ureaplasma urealyticum - pelvic inflammatory disease - syphilis - yaws - gonorrhea - chancroid - lymphogranuloma venereum - donovanosis - orchitis - 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 - leprosy - plague - plague prophylaxs - leptospirosis - eye disease - trachoma - inclusion conjunctivitis - acute otitis media - malaria - anoplura (lice) [7] Contraindications: 1) pregnant women 2) children 3) avoid in ESRD Dosage: 1) take on an empty stomach (food impairs absorption) 2) 250-500 mg IV/PO QID 3) 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: 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: 1) well distributed to most body tissues & fluids 2) approximately 60% excreted unchanged in the urine 3) hemodialysis removes 20-30%, 5-20% [6] 4) peritoneal dialysis has no effect 5) elimination 1/2life is 11 hours with normal renal function & 57-108 hours in anuric patients 6) dose adjustment indicated for renal insufficiency Adverse effects: 1) common (> 10%) - discoloration of teeth & enamel hypoplasia (infants) 2) less common (1-10%) - nausea, diarrhea, photosensitivity 3) 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 4) other - phototoxicity - tooth deposition - 2-fold increased risk of miscarriage [8] Drug interactions: 1) decreased absorption of tetracycline with: a) aluminum b) bismuth c) iron d) magnesium e) bicarbonate f) sucralfate 2) decreased serum concentrations of tetracyclines when coadministered with: a) barbiturates b) carbamazepine c) hydantoins 3) tetracyclines can increase serum concentration of: - digoxin 4) food & dairy products interfere with absorption of tetracycline Laboratory: - tetracycline in specimen - tetracycline in serum/plasma Mechanism of action: 1) bacteriostatic 2) inhibits bacterial protein synthesis 3) inhibits matrix metalloproteinases (matrixins)

Interactions

drug interactions

Related

glycylcycline matrixin or matrix metalloproteinase

Specific

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

General

antibacterial agent

Properties

MISC-INFO: elimination route LIVER KIDNEY pregnancy-category D safety in lactation -

Database Correlations

Kegg map/map00253

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 164
  3. Sanford Guide to antimicrobial therapy 1997
  4. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  5. Prescriber's Letter 6(10):58, Oct, 1999
  6. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  7. Deprecated Reference
  8. Muanda FT, Sheehy O, Berard A Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017 May 1;189:E625-33 PMID: 28461374 http://www.cmaj.ca/content/189/17/E625.full.pdf+html

Component-of

bismuth subcitrate/metronidazole/tetracycline bismuth subsalicylate/metronidazole/tetracycline cortisol/diphenhydramine/nystatin/tetracycline Helidac kit (triple therapy) metronidazole/subsalicylate/tetracycline (Pylera) metronidazole/tetracycline