Pharmacologic class: Tetracycline
Therapeutic class: Anti-infective
Pregnancy risk category B (topical form), D (oral form)
Unknown. Thought to inhibit bacterial protein synthesis at level of 30S and 50S bacterial ribosomes and to alter cytoplasmic membrane of susceptible organisms.
Capsules: 250 mg, 500 mg
Indications and dosages
➣ Mild to moderate infections caused by susceptible organisms
Adults: 500 mg P.O. b.i.d. or 250 mg P.O. q.i.d.
➣ Severe infections caused by susceptible organisms
Adults: 500 mg P.O. q.i.d.
Children older than age 8: 25 to 50 mg/kg P.O. q.i.d.
➣ Syphilis in penicillin-allergic patients
Adults: 500 mg P.O. q.i.d. for 14 days
➣ Late syphilis (except neurosyphilis)
Adults: 500 mg P.O. q.i.d. for 28 days
➣ Leptospirosis when penicillin is contraindicated or ineffective
Adults: 1 to 2 g P.O. daily in two to four divided doses for 5 to 7 days
Adults: 1 to 2 g P.O. daily in two to four divided doses for 10 to 14 days
➣ Gonorrhea in penicillin-allergic patients
Adults: Initially, 1.5 g P.O., followed by 500 mg P.O. q 6 hours for 4 days, up to a total of 9 g
➣ Uncomplicated urethral, endocervical, or rectal infections caused by
Adults: 500 mg P.O. q.i.d. for 7 days
➣ Rickettsial and mycoplasmal infections
Adults: 1 to 2 g P.O. daily in two to four divided doses for 7 days
➣ Helicobacter pylori infection
Adults: In patients with active duodenal ulcer, 500 mg P.O. q.i.d. at meals and bedtime for 14 days, given with other drugs (such as metronidazole, bismuth subsalicylate, amoxicillin, or omeprazole)
Adults: 500 mg P.O. q.i.d. for 3 weeks, given with streptomycin I.M. b.i.d. during week 1 and streptomycin once daily during week 2
➣ Granuloma inguinale; chancroid
Adults: 1 to 2 g P.O. daily in two to four divided doses for 2 to 4 weeks
Adults: 500 mg P.O. q 6 hours for 48 to 72 hours
➣ Plague when streptomycin is contraindicated or ineffective
Adults: 2 to 4 g P.O. q.i.d. for 10 days
Children older than age 8: 30 to 40 mg/kg P.O. q.i.d. for 10 to 14 days
➣ Tularemia as an alternative to streptomycin
Adults: 1 to 2 g P.O. daily in two to four divided doses for 1 to 2 weeks
➣ Campylobacter infection
Adults: 1 to 2 g P.O. daily in two to four divided doses for 10 days
➣ Relapsing fever caused by Borrelia recurrentis
Adults: 1 to 2 g P.O. daily in two to four divided doses for 7 days or until patient is afebrile
➣ Adjunctive treatment of inflammatory acne
Adults and adolescents: 500 mg to 1 g P.O. q.i.d. for 1 to 2 weeks, decreased gradually to 125 to 500 mg P.O. daily
• Renal impairment
• Lyme disease
• Sclerosing agent to control pleural effusions
• Hypersensitivity to drug, other tetracyclines, bisulfites, or alcohol (in some products)
Use cautiously in:
• renal disease, hepatic impairment, nephrogenic diabetes insipidus
• cachectic or debilitated patients
• pregnant or breastfeeding patients (except in anthrax treatment)
• children younger than age 8 (except in anthrax treatment).
• Give with 8 oz of water at least 1 hour before or 2 hours after a meal (especially if it includes milk or other dairy products), antacids, laxatives, or antidiarrheal drugs.
CNS: paresthesia, benign intracranial hypertension
EENT: abnormal conjunctival pigmentation, hoarseness, pharyngitis
GI: nausea, vomiting, diarrhea, loose bulky stools, esophageal ulcers, epigastric distress, enterocolitis, oral and anogenital candidiasis, stomatitis, black hairy tongue, glossitis, anorexia, pancreatitis
GU: dark yellow or brown urine, vaginal candidiasis, anogenital lesions
Hematologic: eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia, thrombocytopenia purpura
Hepatic: fatty liver
Musculoskeletal: retarded bone growth, polyarthralgia
Respiratory: pulmonary infiltrates
Skin: photosensitivity, maculopapular or erythematous rash, increased pigmentation, urticaria, onycholysis
Other: permanent tooth discoloration (in children younger than age 8), tooth enamel defects, superinfection, hypersensitivity reactions including anaphylaxis, serum sickness-like reaction, exacerbation of systemic lupus erythematosus
Drug-drug. Adsorbent antidiarrheals, antacids, calcium, cholestyramine, cimetidine, colestipol, iron, magnesium, sodium bicarbonate: decreased tetracycline absorption
Digoxin: increased digoxin blood level, greater risk of toxicity
Hormonal contraceptives: decreased contraceptive efficacy
Insulin: reduced insulin requirement
Lithium: increased or decreased lithium blood level
Methoxyflurane: increased risk of nephrotoxicity
Penicillin: decreased penicillin activity
Sucralfate: prevention of tetracycline absorption from GI tract
Warfarin: enhanced warfarin effects
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, bilirubin, blood urea nitrogen: increased levels
Hemoglobin, neutrophils, platelets, white blood cells: decreased levels
Urinary catecholamines: false elevation
Drug-food. Dairy products, foods containing calcium: decreased drug absorption
Drug-behaviors. Alcohol use: decreased drug efficacy
Sun exposure: increased risk of photosensitivity
• Monitor for signs and symptoms of superinfection and hypersensitivity reaction.
• With long-term use, monitor CBC, liver function tests, and (in prepubertal patients) bone growth.
• Assess neurologic status. Stay alert for benign intracranial hypertension (especially in children).
• Tell patient to take oral form with 8 oz of water at least 1 hour before or 2 hours after eating a meal, consuming dairy products, or taking antacids, laxatives, or antidiarrheal drugs. Advise him to take last daily dose at least 1 hour before bedtime.
• Stress importance of completing entire course of therapy as ordered, even after symptoms improve.
Caution patient not to use outdated tetracycline, because it may cause serious kidney disease.
• Teach patient to recognize and report signs and symptoms of yeast infection and other infections.
• With long-term therapy, tell patient he'll undergo regular blood testing. Advise parents that prepubertal child should have periodic bone X-rays.
• Caution patient to avoid alcohol during therapy.
• Tell parents that tetracycline use during tooth development period (last half of pregnancy, infancy, and childhood to age 8) may cause permanent yellow, gray, or brownish tooth discoloration.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and behaviors mentioned above.