Adult Dosing
Infections due to susceptible isolates of the designated bacteria
- Initial: 200 mg IV, then 100 mg IV q12hr; max: 400 mg
Pediatric Dosing
Infections due to susceptible isolates of the designated bacteria
- Child <8 years: Not recommended in children < 8 years age due to potential for tooth discoloration
- Child 8 years or older: 4 mg/kg IV, then 2 mg/kg IV q12hr; not to exceed adult dose (100 mg IV q12hr)
Note:
- Rapid administration is to be avoided
- Parenteral therapy is indicated only when oral therapy is not adequate or tolerated
- Oral therapy should be instituted as soon as possible
[Outline]
- Minocycline can cause fetal harm when administered to pregnant women. If tetracycline is used in pregnant women or if the patient becomes pregnant while taking the treatment, the patient should be appraised of the potential hazard to the fetus
- Minocycline can cause permanent discoloration of teeth and enamel hypoplasia, hence should not be used during tooth development (last half of pregnancy, infancy, <8 yrs)
- Reversible decrease in the fibula growth rate has been observed in premature human infants, given oral tetracycline, as tetracyclines form a stable calcium complex in any bone-forming tissue
- Fatal cases of Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) have been reported with minocycline use. Immediately discontinue the drug if this syndrome occurs
- Higher serum levels of tetracycline may lead to azotemia, hyperphosphatemia, and acidosis, in patients with significantly impaired renal function. Monitor creatinine and BUN periodically and do not exceed the total daily dose of 200 mg/day
- If renal impairment exists, even usual oral or parenteral doses can lead to systemic accumulation of the drug and possible liver toxic
- Minocycline can cause photosensitivity manifested by an exaggerated sunburn reaction
- Patients should be cautioned about driving vehicles or using hazardous machinery while on minocycline therapy, as it can cause CNS symptoms like light-headedness, dizziness, or vertigo. These symptoms usually disappears after discontinuation of the treatment
- Clostridium difficile associated diarrhea (CDAD) ranging from mild diarrhea to fatal colitis occurs with minocycline therapy as antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile
- C. difficile produces toxins A and B which contribute to CDAD. Hypertoxin producing strains causes increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy. Careful medical examination is necessary since CDAD may occur >2 months after administration of drug
- If CDAD is suspected/confirmed discontinue the treatment, provide fluid, electrolyte, and protein supplementation along with antibiotics for C. difficile, surgical evaluation as clinically needed
- Minocycline can result in overgrowth of non-susceptible organisms, including fungi, discontinue the drug if superinfection occurs and institute appropriate therapy
- Prescribing antibiotics in the absence of proven or strongly suspected bacterial infection increases the risk of development of drug-resistant bacteria
- Pseudotumor cerebri (benign intracranial hypertension) manifestations as headache and blurred vision, bulging fortanels in infants has been observed with the use of tetracyclines
- Hepatotoxicity including fulminant hepatic failure has been reported with minocycline, use cautiously in patients with hepatic dysfunction and in conjunction with other hepatotoxic drugs
- Drug-induced lupus-like syndrome, autoimmune hepatitis, vasculitis and serum sickness manifested by fever, rash, arthralgia, and malaise have been reported with long-term use of minocycline. Discontinue the drug immediately and perform liver function tests, ANA, CBC, and other appropriate tests if autoimmune syndromes suspected
- Concomitant use of isotretinoin is not recommended due to additive risk of pseudotumor cerebri
- Not recommended for either gender attempting child conception
Caution: Use cautiously in
- Renal impairment
- Hepatic impairment
- Concomitant use of hepatotoxic drug
- SLE
Pregnancy Category:D
Breastfeeding: Because of possible staining of infants' dental enamel or bone deposition of tetracyclines, many reviews state that tetracyclines are contraindicated during breastfeeding. However Short-term use of minocycline is acceptable in nursing mothers as short-term use of minocycline is not likely to harm during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breastmilk. Avoid prolonged or repeat courses during nursing. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhea or candidiasis (thrush, diaper rash). Black discoloration of breastmilk has been reported with minocycline. This data is based on upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 03 July 2013). Because of the potential for serious adverse reactions in nursing infants from the tetracyclines, manufacturer recommends that a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
