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Paul A. Pham Pharm.D. and John G. Bartlett M.D.
08-24-2009
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Available formulations in Zambia: eye ointment: 1% (hydrochloride).
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Doxycycline is the preferred oral tetracycline.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Alternative in PCN-allergic patients: syphilis, yaws, Vincent's infections, and infections caused by N. gonorrhoeae, B. anthracis, L. monocytogenes, Actinomyces sp., and Clostridium sp.
- URI and lower respiratory tract infections; skin and soft tissue infections; Granuloma inguinale;psittacosis caused by Chlamydia psittaci.
- Typhus infections,Rocky Mountain Spotted Fever, rickettsial infections, and Q fever.
- Infections caused by Chlamydia trachomatis.
- Urinary tract infections.
- Infections caused by Borrelia sp., Bartonellabacilliformis, H. ducreyi, F. tularensis, Y. pestis, V. cholerae, Brucella sp., C. fetus.
- Adjunctive to intestinal amebiasis cause by E. histolytica.
- Infections caused by susceptible strains of E. coli, Enterobacter aerogenes, Shigella sp., Acinetobacter sp. Klebsiella sp., Bacteroides sp.
- (in combination with bismuth subsalicylate and metronidazole).
- Gingivitis/periodontitis
- Acne vulgaris
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Sumycin | Tetracycline HCL | ~Par | PO
cap
250mg | $0.08 |
|
|
|
| PO
cap
500mg | $0.17 |
|
|
|
| PO
susp
125mg/5mL (16oz) | $75.00 |
| Tetracycline | Tetracycline HCI | ~Various | PO
cap
250mg | $0.09 |
|
|
|
| PO
cap
500mg | $0.20 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
250-500 mg PO four times a day on an empty stomach.
Usual dose.
Avoid tetracycline, use doxycycline.
Avoid tetracycline, use doxycycline.
Avoid tetracycline, use doxycycline.
Avoid tetracycline, use doxycycline.
Avoid tetracycline, use doxycycline.
- GI upset and diarrhea
- Stains & deforms teeth in children < 8 yrs
- Severe phlebitis with IV infusion (no longer available in the U.S.)
-
Hepatotoxicity (dose related, especially seen in pregnant women, pts w/ renal insufficiency, and with the use of expired medication)
- Worsening azotemia (increased in patients with renal failure). Doxycycline preferred in pts with renal insufficiency.
- Esophageal ulcerations
- Candidiasis (thrush and vaginitis)
- Photosensitivity
- Allergic reactions
- Visual disturbances
- Aggravation of myasthenia gravis (reversed with calcium)
- colitis (less likely compared to cephalosporins, carbapenems, and fluoroquinolones)
- Hemolytic anemia
- Benign intracranial hypertension, papilledema
- Fanconi syndrome (with outdated drugs)
| Drug | Effect of Interaction | Recommendations/Comments |
| Penicillins | In vitro antagonism when co-administered. Bacteriocidal effect of penicillins may be diminished in vivo. | Avoid co-administration. |
| Acitretin | May increase intracranial pressure. | Contraindicated |
| Bismuth salts (bismuth subsalicylate-pepto-bismol) | Bismuth salts chelate tetracyclines resulting in a decreased absorption of tetracycline. | Administer bismuth 2 hrs after tetracycline. |
| Carbamazepine | Coadministration may decrease tetracyclines serum concentrations. | Avoid carbamazepine co-administration. Monitor closely for tetracycline therapy failure. |
| Cholestyramine | Coadministration may significantly reduce tetracyclines absorption | Avoid co-administration |
| Colestipol | Coadministration significantly reduce tetracyclines absorption | Avoid co-administration |
| ddI (buffer in peds formulation) contains cations: | Polyvalent metal cations form an insoluble chelate with tetracyclines resulting in decreased absorption and serum levels of tetracyclines | Separate administration by 4 hrs. |
| Digoxin | Coadministration may result in increased digoxin concentration (in about 10% of pts). | Monitor serum level with sign and symptoms of digoxin toxicity. |
| Methoxyflurane | Case reports of renal failure with co-administration with tetracycline | Avoid co-administration. |
| Non-depolarizing neuromuscular blocker (e.g vecuronium, pancuronium, rocuronium) | May potentiate non-depolarizing neuromuscular blocker | Use with close monitoring. |
| Oral contraceptives | Tetracyclines may decrease the efficacy of oral contraceptives | Consider an additional form of contraception. |
| Phenobarbital | Coadministration may decrease tetracyclines serum concentrations. | Avoid phenobarbital co-administration. Monitor closely tetracycline for therapy failure. |
| Phenytoin | Coadministration may decrease tetracyclines serum concentrations. | Avoid phenytoin co-administration. Monitor closely for tetracycline therapy failure. |
| Polyvalent metal cations (aluminum, zinc, magnesium, iron, calcium [milk]) | Polyvalent metal cations form an insoluble chelate with tetracyclines resulting in decreased absorption. | Separate administration by 4 hrs. |
| Quinapril | Magnesium excipient may reduce tetracyclines absorption. | Avoid co-administration |
| Rifabutin | Coadministration may decrease tetracyclines serum concentrations. | Avoid rifabutin co-administration. Monitor closely for tetracycline therapy failure. |
| Rifampin | Coadministration may decrease tetracyclines serum concentrations. | Avoid rifampin co-administration. Monitor closely for tetracycline therapy failure. |
| Urinary alkalinizers (sodium lactate, sodium bicarbonate) | Coadministration results in increased urinary excretion of tetracyclines by 24-65% | Avoid co-administration. |
| Warfarin | Coadministration may increase INR. | Monitor INR closely. |
- MIC breakpoint for Enterobacteriaceae, Staphylococcus spp., and Enterococcus spp. : < 4 mcg/mL (sensitive); 8 mcg/mL (intermediate); > 16 mcg/mL (resistant).
- Isolates that are susceptible tetracycline are also considered susceptible to doxycycline and minocycline. However, tetracycline-intermediate or -resistant isolates may be susceptible to doxycycline or minocycline.
Oral tetracycline has broad activity, but doxycycline is usually preferred due to twice a day dosing convenience without regard to meals. Tetracycline has role for the treatment of susceptible organisms causing UTIs since it achieves good urinary levels compared to the hepatically metabolized doxycycline, minocycline and tigecycline.
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