Antibiotics Review _ __________________________________________________________________________
THE TETRACYCLINES
Agent
Adult Dosing Range
Pediatric Dosing Range a
Route
Common Side Effects
Comments
Short-Acting Tetracycline
Polyvalent cations decrease absorption.
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
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
Initial: (IV, PO): 4 mg/kg/dose
PO, IV GI upset, tooth
Minocycline
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
Short-Acting Tetracyclines The short-acting tetracyclines include tetracycline, the name- sake of the class. Frequent dosing is needed because of the very short half-life of these agents. The class previously included oxy- tetracycline, but the agent is no longer available in the United States [6]. Tetracycline is inexpensive but requires dosing every six hours for most indications. A less frequent dosage protocol is commonly used for the treatment and prevention of acne [6]. 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
As a result of decades of clinical and agricultural use, the prevalence of resistance to tetracyclines is now high among common gram-positive and gram-negative pathogens. For this reason, and because they are bacteriostatic, the role of tetracyclines is limited for treatment of most pyogenic infec- tions. Primary indications for this class are atypical infections (e.g. mycoplasma and chlamydia) and zoonoses (e.g. tularemia and brucellosis). The tetracyclines may be divided into three groups based on their pharmacokinetic traits. These groups are the short-acting group, intermediate-acting group, and long-acting group. The varying half-lives are the result of different rates of renal excretion [6].
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