___________________________________________________________________________ Antibiotics Review
THE TETRACYCLINES
Agent
Adult Dosing Range
Pediatric Dosing Range a
Route
Common Side Effects
Comments
Short-Acting Tetracycline
250–500 mg every 6 to 12 hrs
25–50 mg/kg/day in 4 divided doses
PO Photosensitivity, tooth enamel deformities in children <8 yrs of age
Polyvalent cations decrease absorption.
Intermediate-Acting Demeclocycline
150 mg every 6 hrs or 300 mg every 12 hrs
≥8 years: 8–12 mg/ kg/day in 2 to 4 divided doses
PO GI upset, tooth
Polyvalent cations decrease absorption. Use caution if used with warfarin.
enamel deformities in children <8 yrs of age
Long-Acting Doxycycline
PO: 100–200 mg/ day in 1 to 2 divided doses IV: 100 mg every 12 hrs Initial: (IV, PO): 200 mg Maintenance: (IV): 100 mg every 12 hrs Max: 400 mg/day Maintenance (PO): 100 mg every 12 hrs, OR 100–200 mg initially, followed by 50 mg 4 times daily
<45 kg: 2–5 mg/kg/ day in 1 to 2 divided doses Max: 200 mg/day >45 mg: Same as adult dosing
PO, IV Phlebitis at IV site, photosensitivity,
Polyvalent cations decrease absorption. Use caution if used with warfarin.
tooth enamel deformities in children <8 yrs of age
Minocycline
Initial: (IV, PO): 4 mg/kg/dose
PO, IV GI upset, tooth
enamel deformities in children <8 yrs of age
Maintenance: 2 mg/ kg/dose every 12 hrs Max: 400 mg/day
Prescribing information is given for comparison purposes only. The higher dosage ranges reflect dosages for more severe infections. Please consult the manufacturer’s package insert for the antibiotic for complete prescribing information, maximum dosages, and indications. SIADH: syndrome of inappropriate antidiuretic hormone hypersecretion. a All pediatric doses are for children older than 8 years of age. Source: [6; 16] Table 8
Intermediate-Acting Tetracyclines The only intermediate-acting agent available in the United States is demeclocycline. Demeclocycline is no longer used as an antibiotic but rather has been used as an off-label drug to treat the syndrome of inappropriate antidiuretic hormone (SIADH) [6; 141]. However, studies have suggested that there is limited high-quality evidence to suggest that demeclocycline is effective in managing this condition, and European clinical practice guidelines recommend against the use of demeclocy- cline for the management of hyponatremia in patients with SIADH [6; 142].
Long-Acting Tetracyclines The long-acting tetracycline agents include doxycycline and minocycline. The main difference between these and the short-acting agents is that these may be dosed less frequently (once or twice daily), which is an advantage in ensuring compli- ance [6]. The spectrum of bacterial coverage is essentially the same and the indications are the same, with the additional indication for the treatment of inhalation anthrax as part of a multidrug regimen.
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MDTX2026
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