Category:

• Antibiotic

Description:

• Tetracycline antibiotic

Indications:

• Rickettsiae infections (Rocky Mtn spotted fever, typhus fever, Q fever, rickettsialpox and tick fevers)

• Mycoplasma pneumoniae infections

• Psittacosis and ornithosis

• Lymphogranuloma venereum and granuloma inguinale

• Borrelia recurrentis infections

• Gram-negative infections (E. coli, Enterobacter aerogenes, Shigella species, Acinetobacter calcoaceticus, H. influenzae, Klebsiella species,H. ducreyi, Yersinia pestis, Francisella tularensis, Bartonella bacilliformis, Bacteroides species, Campylobacter fetus, V. cholerae, Brucella species)

• Gram-positive infections (Streptococcus species, S. pyogenes, S. faecalis)

• For infections were penicillin is the drug-of-choice but is contraindicated (N. gonorrhoeae, Treponema pallidum, T. pertenue, Listeria monocytogenes, Clostridium species, Bacillus anthracis, Fusobacterium fusiforme, Actinomyces species,  N. meningitidis)

• Acute intestinal amebiasis

• Acne

• Inclusion conjunctivitis

• Chlamydia trachomatis

• Lyme disease (Borrelia burgdorferi)

Contraindications:

• None

Precautions:

• Pregnancy category D

• Do not use in last half of pregnancy up to 8 years old due to tooth discoloration

• May cause photosensitivity reactions

• Prolonged intraveneous (IV) administration may lead to thrombophlebitis, initiate oral therapy as soon as possible

• Doses greater than 2 grams per day may lead to hepatic function impairment

• Excreted in breast milk

• May cause pseudotumor cerebri (benign intracranial hypertension with symptoms of headache and blurred vision)

• Do not use after expiration date.  Degraded, expired tetracyclines are highly nephrotoxic.

• Administer on an empty stomach, 1 hour before or 2 hours after meals

• Do not take with antacids, iron, aluminum, magnesium or zinc preparations, milk or dairy products

• Take with a full glass of water and remain standing for at least 90 seconds and/or lay down for 60 minutes to decrease occurrence of esophageal ulcers.

• Complete full course of therapy.

Adverse Reactions (Side Effects):

• Anorexia, nausea, vomiting, diarrhea, epigastric distress, loose stools, sore throat

• Esophageal ulcers

• Fatty liver, hepatotoxicity, increased BUN levels

• Urticaria

• Local injection site pain  

Dosage:

Administered orally (capsules and suspension) and by IV injection

• Adults:

  • Oral: 1-2 grams per day in 2-4 equal doses

  • Parenteral: 250-500mg q12h

  • Mild/moderate infections: 250mg po qid or 500mg po bid

  • Severe infections: 500mg po qid

• Children (>8 years old):

  • Oral: 25-50mg/kg/day in 4 equal doses

  • Pareneteral: 10-20mg/kg/day (average 12mg/kg/day) in 2 divided doses

• Brucellosis: 

  • 500mg qid for 3 weeks, followed by 1 gram streptomycin

• Syphilis: 

  • 30-40grams in equally divided doses over 10-15 days

• Gonorrhea: 

  • 1.5 gram initially, then 500mg every 6 hours up to a total of 9 grams

• Chlamydia trachomatis infections: 

  • 500mg four times a day for at least 7 days

• Severe acne: 

  • 1 gram per day in divided doses initially, then 125-500mg per day

• Lower resp, skin, bone or joint infection (mild/moderate): 

  • 500mg po q12h or 400mg IV q12h

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001