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10/12/2009
Drugs in this class are used for: Treatment and/or prophylaxis of infections. Tetracyclines are broad-spectrum antibioticsthat work by inhibiting protein synthesis in bacteria. Tetracyclines are used to treat many infections but their use has reduced over time because of bacterial resistance. They are still the treatment of choice in chlamydia, rickettsia, brucella, acne and rosacea. Dosage regimen (NB *Refer to SPC for children’s doses and specific infections). Tetracyclines Drug name | Use | Dosage | Tetracycline | · Non-gonococcal urethritis · Acne vulgaris · Rosacea | By mouth: 250mg every six hours, increased in severe infections to 500mg every six to eight hours. Non-gonococcal urethritis: 500mg every six hours for seven to14 days (21 days if failure or relapse after first course).* | Demeclocycline | · Lyme disease · Bronchitis · Acne · Gonorrhoea, pertussis · UTIs | By mouth: 150mg every six hours or 300mg every 12 hours. * | Doxycycline | · Syphilis · Chlamydia · Non-gonococcal urethrits · Anthrax | By mouth: 200mg on the first day then 100mg daily; 200mg daily in severe infections. Early syphilis: 100mg twice daily for 14 days; late latent syphilis: 200mg twice daily for 28 days. Uncomplicated genital chlamydia, non-gonococcal urethritis: 100mg twice daily for seven days. Anthrax: 100mg twice daily.* | Minocycline | · Acne vulgaris · Meningococcal prophylaxis | By mouth: 100mg twice daily. Meningitis prophylaxis: 100mg twice daily for five days (not for children). | Oxytetracycline | · Acne vulgaris and rosacea | By mouth: 250-500mg every six hours. Rosacea: 500mg twice daily. | Tigecycline | · Complicated intra-abdominal infections · Complicated skin and soft tissue infections | By IV infusion: Adult over 18years, initially 100mg, then 50mg every 12 hours for five to14 days.* |
Patient knowledge Patient should be: - Aware of treatment and/or prophylaxis procedure.
- Tetracycline, doxycycline and minocycline should be swallowed whole with plenty of fluid while sitting or standing.
- Patients should be advised not to take milk, indigestion remedies or medicines containing iron or zinc at the same time as tetracyclines so that its absorption is not affected.
- Demeclocycline and oxytetracycline should be taken an hour before food or on an empty stomach.
- Avoid use with anticoagulants, ciclosporins (doxycycline only) and retinoids.
- Avoid exposure to sunlight or sun lamps when taking demeclocycline or doxycycline.
Is the medicine working? - Most infections need a short course of antibiotics but if infections are recurrent perhaps patient compliance needs to be analysed.
Side effects - Gastro-intestinal disturbances (eg nausea, vomiting, diarrhoea).
- Dysphagia.
- Oesophageal irritation.
- Hypersensitivity reactions (eg rashes).
- Headache and visual disturbances (discontinue treatment).
- Minocyclines in particular can cause dizziness, vertigo and sometimes irreversible pigmentation.
- Can stain the developing teeth of children so should be avoided in children under 12 years, pregnant and breast feeding women.
Monitoring Lifestyle - Maintain a varied, healthy diet to build up the immune system.
- Ensure adequate hydration (especially in the elderly and children).
- Patients should be aware of all possible symptoms in case infection relapses.
- Encourage compliance to minimise risk of antibiotic resistance.
Anita Bagga is a Boots community pharmacist from Leicester. Go back to |  | 
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