te-tra-SYE-kleen

Therapeutic Classification: anti-infectives

Pharmacologic Classification: tetracyclines

• Treatment of various infections due to unusual organisms, including::
  • Mycoplasma,
  • Chlamydia,
  • Rickettsia,
  • Borrelia burgdorferi.
• Treatment of gonorrhea and syphilis in penicillin-allergic patients.
• Prevention of exacerbations of chronic bronchitis.
• Treatment of acne.

• Inhibits bacterial protein synthesis at the level of the 30S bacterial ribosome.

• Bacteriostatic action against susceptible bacteria.

Spectrum:

• Includes activity against some gram-positive pathogens::
  • Bacillus anthracis,
  • Clostridium perfringens,
  • Clostridium tetani,
  • Listeria monocytogenes,
  • Nocardia,
  • Propionibacterium acnes,
  • Actinomyces israelii.
• Active against some gram-negative pathogens::
  • Haemophilus influenzae,
  • Legionella pneumophila,
  • Yersinia entercolitica,
  • Yersinia pestis,
  • Neisseria gonorrhoeae,
  • Neisseria meningitidis.
• Also active against several other pathogens, including::
  • Mycoplasma,
  • Treponema pallidum,
  • Chlamydia,
  • Rickettsia,
  • B. burgdorferi.

Absorption: 60–80% absorbed after oral administration.

Distribution: Widely distributed, some CSF and good bone penetration; crosses the placenta and enters breast milk.

Metabolism/Excretion: Excreted mostly unchanged by the kidneys.

Half-life: 6–12 hr.

(blood levels)

Contraindicated in:

• Hypersensitivity
• Some products contain alcohol or bisulfites and should be avoided in patients with known hypersensitivity or intolerance
• Pedi: Children <8 yr (permanent staining of teeth)
• OB: Risk of permanent staining of teeth in infant if used during last half of pregnancy
• Lactation: Lactation.

Use Cautiously in:

• Cachectic or debilitated patients
• Renal disease
• Nephrogenic diabetes insipidus.
• OB: Women of childbearing age

Derm: photosensitivity, rashes.

GI: diarrhea, nausea, vomiting, esophagitis, hepatotoxicity, pancreatitis.

Hemat: blood dyscrasias.

Neuro: dizziness, intracranial hypertension.
Misc: hypersensitivity reactions, superinfection.

Drug-Drug:

• May ↑ the effect of warfarin.
• May ↓ effectiveness of estrogen-containing oral contraceptives.
• Antacids, calcium, iron, and magnesium form insoluble compounds (chelates) and ↓ absorption of tetracycline.
• Sucralfate may bind to tetracycline and prevent its absorption from the GI tract.
• Cholestyramine orcolestipol↓ absorption.
• Adsorbentantidiarrheal agents may ↓ absorption.
• Barbiturates, phenytoin, orcarbamazepine may ↓ activity of doxycycline.
• Isotretinoin may ↑ risk of intracranial hypertension; avoid concomitant use

Drug-Food:

• Calcium in foods or dairy products↓ absorption by forming insoluble compounds (chelates).

• PO (Adults): 250–500 mg q 6 hr or 500 mg–1 g q 12 hr. Chronic treatment of acne: 500 mg–2 g/day for 3 wk, then ↓ to 125 mg–1 g/day.
• PO (Children 8 yr): 6.25–12.5 mg/kg q 6 hr or 12.5–25 mg/kg q 12 hr.

(Generic available)

• Capsules: 250 mg; 500 mg;
• In combination with: bismuth subcitrate potassium and metronidazole (Pylera). See Appendix [not included in this PDA edition].

• Infection: Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.

• Renal and hepatic functions and CBC should be monitored periodically during long-term therapy.
  • May cause ↑ AST, ALT, serum alkaline phosphatase, bilirubin, and amylase concentrations. Tetracyclines, except doxycycline, may cause elevated serum BUN.
  • May cause false ↑ in urinary catecholamine levels.

• May cause yellow-brown discoloration and softening of teeth and bones if administered prenatally or during early childhood. Not recommended for children <8 yr of age or during pregnancy or lactation.
• PO: Administer around the clock. Administer at least 1 hr before or 2 hr after meals. Administer with a full glass of liquid at least 1 hr before going to bed to avoid esophageal ulceration.
  • Avoid administration of calcium, antacids, magnesium-containing medications, sodium bicarbonate, or iron supplements within 1–3 hr of tetracycline.

• Instruct patient to take medication around the clock and to finish the drug completely, as directed, even if feeling better. If a dose is missed, take as soon as possible unless almost time for next dose; do not double doses. Advise patient that sharing of this medication may be dangerous.
  • Advise patient to avoid taking milk or other dairy products concurrently with tetracycline. Also avoid taking antacids, calcium, magnesium-containing medications, sodium bicarbonate, and iron supplements within 1–3 hr of tetracycline.
  • Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
  • Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) or intracranial hypertension (headache, blurred vision, diplopia, vision loss). Women who are overweight, of childbearing age or have a history of intracranial hypertension are at greater risk for developing tetracycline-associated intracranial hypertension. Skin rash, pruritus, and urticaria should also be reported.
  • Instruct patient to notify health care professional of medication regimen before treatment or surgery.
  • Advise female patients to use a nonhormonal method of contraception while taking tetracycline and until next menstrual period.
  • Instruct patient to notify health care professional if symptoms do not improve within a few days for systemic preparations.
  • Caution patient to discard outdated or decomposed tetracycline; may be toxic.

• Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
• Decrease in acne lesions.

Sumycin