Tetracycline

Tetracycline is an antibiotic meant to treat skin infections, lesions, and disorders

 

What are tetracyclines?

Tetracyclines are a group of antibiotics that are commonly used to treat skin infections. These drugs, which were originally produced from the soil bacterium Streptomyces aureofaciens, have been used for almost 50 years.

Chlortetracycline, tetracycline, and oxytetracycline, the original base medications, have been superseded by products that are more absorbed, more lipophilic, and have good tissue distribution. These are some of them:

  • Doxycycline
  • Lymecycline
  • Minocycline
  • Sarecycline.

The antibiotic doxycycline is the most widely prescribed.

Tetracyclines that have been chemically changed are being developed to diminish antibacterial activity while increasing their anti-inflammatory effect.

What are tetracyclines used for?

Tetracyclines are broad-spectrum antibiotics that are commonly used to treat infections of the skin, chest, urethra, and pelvis. Syphilis, Lyme disease, Q fever, Rocky Mountain spotted fever, and plague are among the illnesses for which doxycycline is prescribed. It’s also commonly used to prevent malaria.

Doxycycline can also be used to treat non-infectious inflammatory skin and mucosal illnesses, such as:

  • Acne vulgaris
  • Rosacea
  • Periorificial dermatitis
  • Hidradenitis suppurativa
  • Recurrent aphthous stomatitis
  • Bullous pemphigoid
  • Granulomatous disorders such as sarcoidosis
  • Pyoderma gangrenosum
  • Acute febrile neutrophilic dermatosis
  • Pityriasis lichenoides chronica.

It’s worth noting that using tetracyclines doesn’t make Staphylococcus aureus more resistant.

How do tetracyclines work?

Tetracyclines operate as antibiotics by interfering with susceptible bacteria’s protein synthesis.

They also have anti-inflammatory properties.

  • They inhibit matrix metalloproteinases (MMP), hydrolases, and phospholipase A2 — these enzymes are active in dermal inflammatory skin disorders.
  • They reduce production of pro-inflammatory cytokines such as TNF-a, IL-1B, and IL-6.
  • They are antioxidants, reducing free radical production and nitric oxide.
  • They inhibit angiogenesis and granuloma formation.

What is the usual dose?

Doxycycline is an antibiotic that is taken once or twice a day. It should be consumed when standing up and with plenty of water.

In rosacea, lower doses of doxycycline have been demonstrated to be helpful (20 mg twice daily or 40 mg once daily). In New Zealand, the lowest dose of doxycycline is 50 mg. The effect of low-dose doxycycline on other skin conditions is uncertain, and antibiotic doses are frequently given.

The Food and Drug Administration in the United States approved a topical foam formulation of minocycline for acne treatment in 2019.

How long are tetracyclines taken for?

Depending on the condition, infections are treated for 7 to 28 days.

Tetracyclines like doxycycline take weeks or months to work in inflammatory conditions. For inflammatory skin conditions, they are frequently recommended for months or years. These disorders are not curable with them.

There is a one to three week lag between changing the dosage and seeing results on the skin. If the skin problem worsens after a dose reduction, go back to the prior higher dose and keep taking it, or take it as your doctor prescribes.

What are the side effects and risks of tetracyclines?

Tetracyclines should not be taken by pregnant or nursing women, or children under the age of 12, because they discolor growing teeth and can induce enamel hypoplasia (malformed permanent teeth). Permanent tooth staining is usually just transient, although it might last a lifetime. Bone staining is also a possibility.

Doxycycline is frequently well tolerated, especially in subantibiotic doses. Allergies can arise, but they are uncommon. There are a few things to keep in mind.

  • It must be taken when upright and with copious water, to reduce oesophagitis. Wait about an hour before lying down
  • Patients should protect skin and nails from sun exposure, as it is a photosensitiser and can cause unexpected sunburn or acute painful onycholysis
  • It can cause nausea, vomiting, and diarrhoea; it is better tolerated when taken after food than on an empty stomach
  • Women prone to vulvovaginal candidiasis (thrush) with broad-spectrum antibiotics should consider prophylactic treatment with intermittent topical or systemic azole antifungal agent

Minocycline has an increased risk of severe adverse effects compared to doxycycline, so it best to avoid minocycline as a first-line agent. These include:

  • Drug hypersensitivity syndrome
  • Autoimmune reactions
  • Dizziness and headache (intracranial hypertension)
  • With prolonged use, blue pigmentation of skin and nails

Photosensitivity is less likely with minocycline than with doxycycline.

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