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Pregnancy Category: D
ClassificationTherapeutic: anti infectives
Treatment of various infections due to unusual organisms, including::
- Borrelia burgorferi.
Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome.
Bacteriostatic action against susceptible bacteria.Includes activity against some gram-positive pathogens::
- Bacillus anthracis,
- Clostridium perfringens,
- Clostridium tetani,
- Listeria monocytogenes,
- Propionibacterium acnes,
- Actinomyces israelii.
- Haemophilus influenzae,
- Legionella pneumophila,
- Yersinia entercolitica,
- Yersinia pestis,
- Neisseria gonorrhoeae,
- Neisseria meningitidis.
- Treponema pallidum,
- B. burgdorferi.
Absorption: 60–80% absorbed after oral administration.
Distribution: Widely distributed, some CSF and good bone penetration; crosses the placenta and enters breast milk.
Metabolism and Excretion: Excreted mostly unchanged by the kidneys.
Half-life: 6–12 hr.
Time/action profile (blood levels)
|PO||1–2 hr||2–4 hr||6–12 hr|
Contraindicated in: Hypersensitivity; Some products contain alcohol or bisulfites and should be avoided in patients with known hypersensitivity or intolerance; Pediatric: Children <8 yr (permanent staining of teeth); Obstetric: Risk of permanent staining of teeth in infant if used during last half of pregnancy; Lactation: Lactation.
Use Cautiously in: Cachectic or debilitated patients; Renal disease; Nephrogenic diabetes insipidus.
Adverse Reactions/Side Effects
Central nervous system
- benign intracranial hypertension (↑ in children)
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- photosensitivity (most frequent)
- blood dyscrasias
- hypersensitivity reactions
Drug-Drug interactionMay ↑ the effect of warfarin.May ↓ effectiveness of estrogen-containing oral contraceptives.Antacids,calcium, iron, and magnesium form insoluble compounds (chelates) and ↓ absorption of tetracycline.Sucralfate may bind to tetracycline and prevent its absorption from the GI tract.Cholestyramine orcolestipol ↓ absorption.Adsorbentantidiarrheal agents may ↓ absorption.Barbiturates, phenytoin, orcarbamazepine may ↓ activity of doxycycline.Calcium in foods or dairy products ↓ absorption by forming insoluble compounds (chelates).
Oral (Adults) 250–500 mg q 6 hr or 500 mg–1 g q 12 hr. Chronic treatment of acne—500 mg–2 g/day for 3 wk, then ↓ to 125 mg–1 g/day.
Oral (Children ≥8 yr) 6.25–12.5 mg/kg q 6 hr or 12.5–25 mg/kg q 12 hr.
Availability (generic available)
Capsules: 250 mg, 500 mgIn combination with: bismuth subsalicylate tablets and metronidazole tablets (Helidac) as part of a compliance package; bismuth subcitrate potassium and metronidazole (Pylera). See combination drugs.
- Infection: Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Lab Test Considerations: Renal and hepatic functions and CBC should be monitored periodically during long-term therapy.
- May cause ↑ AST, ALT, serum alkaline phosphatase, bilirubin, and amylase concentrations. Tetracyclines, except doxycycline, may cause elevated serum BUN.
- May cause false ↑ in urinary catecholamine levels.
Potential Nursing DiagnosesRisk for infection (Indications, Side Effects)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
Noncompliance (Patient/Family Teaching)
- May cause yellow-brown discoloration and softening of teeth and bones if administered prenatally or during early childhood. Not recommended for children <8 yr of age or during pregnancy or lactation.
- Oral: Administer around the clock. Administer at least 1 hr before or 2 hr after meals. Administer with a full glass of liquid at least 1 hr before going to bed to avoid esophageal ulceration.
- Avoid administration of calcium, antacids, magnesium-containing medications, sodium bicarbonate, or iron supplements within 1–3 hr of tetracycline.
- Instruct patient to take medication around the clock and to finish the drug completely, as directed, even if feeling better. If a dose is missed, take as soon as possible unless almost time for next dose; do not double doses. Advise patient that sharing of this medication may be dangerous.
- Advise patient to avoid taking milk or other dairy products concurrently with tetracycline. Also avoid taking antacids, calcium, magnesium-containing medications, sodium bicarbonate, and iron supplements within 1–3 hr of tetracycline.
- Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
- Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools). Skin rash, pruritus, and urticaria should also be reported.
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Advise female patients to use a nonhormonal method of contraception while taking tetracycline and until next menstrual period.
- Instruct patient to notify health care professional if symptoms do not improve within a few days for systemic preparations.
- Caution patient to discard outdated or decomposed tetracycline; may be toxic.
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
- Decrease in acne lesions.