Tetracycline pop up box.doc

Tetracycline

Antibiotic Class:
Tetracyclines
Antimicrobial Spectrum:
Staphylococcus aureus, Streptococcus pneumonia, Streptococcus pyogenes, Streptooccus
agalacticae, Campylobacter jejuni, Haemophilus influenzae, Neisseria gonorrhoeae, Neisseria
meningitides,Clostridium spp., Peptostreptococcus spp., Peptococcus spp. Bacteroides
melaninogenicus, Bacteroides fragilis

Mechanism of Action:
Inhibits bacterial protein synthesis by binding with the 30S ribosomal subunit.

Pharmacodynamics:
Tetracyclines produce a combination of concentration and time-dependent killing (AUC:MIC
ratio).

Pharmacokinetics:
Dose of 500mg PO: Cmax: 1.5-5 mcg/mL; Tmax: 2-4 hours; Half-life: 6-12 hours; Volume of
distribution: 108 L/kg; Table 3
Adverse Effects:
GI: epigastric burning, abdominal discomfort, nausea, vomiting, anorexia, diarrhea, esophagitis,
esophageal ulcers, dysphagia, candidal superinfections
Teeth and bone: (dose/duration related) yellow discoloration of teeth, which turns into a gray-
brown permanent discoloration, hypoplasia of enamel, teeth demineralization, skeletal growth
retardation
Hepatotoxicity: rare, but fatal; intrahepatic cholestasis, jaundice, azotemia, acidosis, irreversible
shock
Renal Toxicity: hyperphosphatemia, acidosis, polyuria, polydipsia
Photosensitivity and hyperpigmentation: red rash to blistering on sun-exposed areas;
photoallergic reactions manifested by paresthesias of hands, feet, nose, photo-onycholysis
Auditory: tinnitus, hearing loss
Vision: visual disturbances
CNS: lightheadedness, dizziness, ataxia, drowsiness, headache
Dosage:
Oral: 250mg, 500mg capsules
Adult dosing (common indications):
Acne vulgaris: 250 mg PO q other day to 500 mg PO q24h
Bartonellosis: 1-2 g/day divided PO in 2-4 doses
Brucellosis: 500 mg PO q6h 4 x 3 plus streptomycin
Chlamydia psitacci infection: 1-2 g/day divided PO in 2-4 doses
Rickettsial disease: 1-2 g/day divided PO in 2-4 doses
Nongonococcal urethritis: 500 mg PO q6h x 7 days
Pediatric dosing:
25-50mg/kg/day in 2 to 4 divided doses OR 0.6-1.2g/m2 in 2 – 4divided doses
Table 4

Disease state based dosing:
Renal failure: CrCl > 50mL/min: 250mg to 500mg q6h
CrCl 10-50 mL/min: 250mg to 500mg q12h to q24h Hepatic failure: No dosing changes recommended at this time.
Contraindications/Warnings/Precautions:
Contraindications: Hypersensitivity to tetracycline antibiotics.
Precautions: Usage in newborns, infants, and children less than 8 years of age; risk for tooth
discoloration; Renal or liver impairment; Phototoxicity; Veneral disease with suspected
coexistent syphilis
Drug Interactions:
Oral contraceptives: Decreased contraceptive effectiveness
Warfarin: Increased warfarin effect
Barbiturates, phenytoin, carbamazepine: Decreased serum concentrations of doxycycline
Ethanol: Decreased doxycyline serum concentrations
Antacids, didanosine, sucralfate, multivitamins: decreased tetracycline absorption
Kaolin, bismuth subsalicylate: decreased absorption of tetracycline
Food: Decreased absorption of tetracycline
Milk: Decreased absorption of tetracycline
Table 6

Pregnancy:
Category D: Risk established, but benefits may outweigh risk.
Monitoring Requirements:
Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white
blood cell count
Toxic: Hypersensitivity syndrome reaction, serum sickness like reaction or single organ
dysfunction – Monitor: CBC, LFTs, urinalysis, urea, creatinine, chest radiograph; Drug-induced
lupus: monitor antinuclear antibody and hepatic transaminases; General long-term therapy:
Liver and renal function tests, Hematopoietic studies
Brand names/Manufacturer:
Available by many names and manufacturers

Source: http://www.antimicrobe.org/new/drugpopup/Tetracycline.pdf