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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Tetracycline

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
10-19-2010

Zambia Specific Information

  • Available formulations in Zambia: eye ointment: 1% (hydrochloride).
  • Doxycycline is the preferred oral tetracycline.
Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • 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.
NON-FDA APPROVED USES

  • (in combination with bismuth subsalicylate and metronidazole).
  • Gingivitis/periodontitis
  • Acne vulgaris

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
TetracyclineTetracycline HCI~Various generic manufacturers PO
cap
250mg
$0.07
      PO
cap
500mg
$0.12

*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.

USUAL ADULT DOSING

250-500 mg PO four times a day on an empty stomach.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Avoid tetracycline, use doxycycline.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Avoid tetracycline, use doxycycline.

DOSING IN HEMODIALYSIS

Avoid tetracycline, use doxycycline.

DOSING IN PERITONEAL DIALYSIS

Avoid tetracycline, use doxycycline.

DOSING IN HEMOFILTRATION

Avoid tetracycline, use doxycycline.

ADVERSE DRUG REACTIONS

COMMON

  • GI upset and diarrhea
  • Stains & deforms teeth in children < 8 yrs
  • Severe phlebitis with IV infusion (no longer available in the U.S.)
OCCASIONAL

  • 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
RARE

  • 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)
  • Pseudotumor cerebri
  • Pancreatitis

DRUG INTERACTIONS

Drug-to-Drug Interactions

Drug-to-Drug Interaction

DrugEffect of InteractionRecommendations/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 absorptionAvoid 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.

SPECTRUM

Detailed Spectrum of Activity

RESISTANCE

  • 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.

PHARMACOLOGY

Pharmacology

COMMENTS

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.

REFERENCES

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