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PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Tetracyclines

These are broad spectrum antibiotics. The majority were discovered in the 1950's at which time they had a wider spectrum of activity than most other antibiotics.1 They were active against:

Due to increasing bacterial resistance they are now no longer used against staphylococcus, streptococcus or pneumococcus. Minocycline has the widest antibacterial spectrum, as it is also active against Neisseria meningitidis.

Mode of action

Their mechanism of action is by inhibiting essential reactions for vital processes within bacterial cells. e.g. protein synthesis. They can also alter the cytoplasmic membrane, allowing nucleotides and other essential compounds to leak out of the cell. They do not kill bacteria, but inhibit them. Their absorption is affected by dairy products and advice labels usually direct patients to avoid taking milk with the tablets.

Available treatments

They are available as topical, oral or intravenous medication.

Tigecycline is a new antibiotic licensed in the United Kingdom (UK), United States and Europe. It is a broad spectrum glycylcycline antibiotic which has structural similarities to the tetracyclines but is more potent against tetracycline-resistant organisms. It is only available as an intravenous (IV) preparation. It may be used for complicated intra-abdominal, skin and soft tissue infections.2

Indications for use

Where possible treatment should be indicated by sensitivity from a cultured specimen. If empirical treatment is required, your local primary care trust will have produced a formulary with recommended treatments based on knowledge of local prevalent pathogens and resistance.

Tetracyclines are the treatment of choice for infections caused by:

They are also used in:

  • Respiratory or genital mycoplasma infections
  • Destructive periodontal disease, refractory to other treatments5
  • Malaria prophylaxis6
  • Community acquired MRSA7,8
  • Amyotrophic lateral sclerosis: Research has looked into the potential neuroprotective role of minocycline in this disease.9 In combination with Riluzole there were no significant adverse effects, but further work is needed to determine efficacy.
  • Exacerbations of chronic obstructive airways disease - They have some activity against Haemophilus influenzae.
  • Acne:
    • Tetracyclines are used in the treatment of moderate to severe papulopustular acne.10 Minocycline is second line.11
    • Initial treatment is for 3 months.
    • If they are used in combination with topical benzoyl peroxide, there is an increase in the speed and efficacy with which the lesions are reduced.12
  • Leptospirosis:
    • Used as alternative to erythromycin, if penicillin hypersensitive.
  • Post-exposure prophylaxis of anthrax in children: Used where alternative treatment is unavailable - this is an unlicensed use.

Cautions and contra-Indications

Tetracyclines bind to calcium and are deposited in growing bones and teeth, causing brown discolouration. This can occur from the fourth month in-utero until 12 years of age. They also cause dental hypoplasia.

They should not be given to:

  • Pregnant women
  • Children under 12 years - except in anthrax prophylaxis
  • Breast feeding mothers
  • Patients with kidney disease - can worsen renal failure
Adverse effects
  • GI effects - nausea, vomiting, diarrhoea and occasional antibiotic related colitis
  • Sore mouth, dysphagia and oesophagitis
  • Increased photosensitivity

Discontinue treatment if any of the following occur:

  • RARELY - pancreatitis and hepatotoxicity
  • RARELY - blood disorders
  • Hypersensitivity reactions including - rash, Steven's-Johnson syndrome, angioedema, anaphylaxis and pericarditis
  • Headaches or visual disturbances may indicate benign intracranial hypertension. [Bulging fontanelles have been reported in infants.]

Document references
  1. Duggar BM, Singleton VL; Biochemistry of antibiotics. Annu Rev Biochem. 1953;22:459-96.
  2. Hylands J; Tigecycline: A new antibiotic. Intensive Crit Care Nurs. 2008 Aug;24(4):260-3. Epub 2008 Jun 12. [abstract]
  3. Senn L, Hammerschlag MR, Greub G; Therapeutic approaches to Chlamydia infections. Expert Opin Pharmacother. 2005 Oct;6(13):2281-90. [abstract]
  4. Bratton RL, Whiteside JW, Hovan MJ, et al; Diagnosis and treatment of Lyme disease. Mayo Clin Proc. 2008 May;83(5):566-71. [abstract]
  5. Gottehrer NR; Antimicrobials in periodontics: controlling chronic disease. Dent Today. 2008 Apr;27(4):128, 130-1.
  6. WHO; The use of antimalarial drugs, part II: 1.10 antibiotics used as antimalrial drugs. World Health Organisation.
  7. Avdic E, Cosgrove SE; Management and control strategies for community-associated methicillin-resistant Staphylococcus aureus. Expert Opin Pharmacother. 2008 Jun;9(9):1463-79. [abstract]
  8. Stryjewski ME, Chambers HF; Skin and soft-tissue infections caused by community-acquired methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2008 Jun 1;46 Suppl 5:S368-77. [abstract]
  9. Pontieri FE, Ricci A, Pellicano C, et al; Minocycline in amyotrophic lateral sclerosis: a pilot study. Neurol Sci. 2005 Oct;26(4):285-7. [abstract]
  10. Acne vulgaris, Clinical Knowledge Summaries (2006)
  11. Garner SE, Eady EA, Popescu C, Newton J, Li Wan Po A. Minocycline for acne vulgaris: efficacy and safety. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002086. DOI: 10.1002/14651858.CD002086.
  12. Bowman S, Gold M, Nasir A, et al; Comparison of clindamycin/benzoyl peroxide, tretinoin plus clindamycin, and the combination of clindamycin/benzoyl peroxide and tretinoin plus clindamycin in the treatment of acne vulgaris: a randomized, blinded study. J Drugs Dermatol. 2005 Sep-Oct;4(5):611-8. [abstract]
AcknowledgementsEMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
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Document Version: 2
DocRef: bgp25096
Last Updated: 16 Jul 2008
Review Date: 16 Jul 2009












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See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

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