Tetracyclines are medications of choice for most infections due to Chlamydia, Chlamydophila, Mycoplasma, Rickettsia, Ehrlichia, and Vibrio organisms and for some spirochetal infections. STDs in which chlamydiae often play a role—endocervicitis, urethritis, proctitis, and epididymitis—should be treated with doxycycline for 7–14 days. Pelvic inflammatory disease is often treated with doxycycline plus cefoxitin or cefotetan. Other chlamydial infections (psittacosis, lymphogranuloma venereum, trachoma) and STDs (granuloma inguinale) also respond to doxycycline. Other uses include treatment of acne, respiratory infections, Lyme disease and relapsing fever, brucellosis, glanders, tularemia (often in combination with streptomycin), cholera, mycoplasmal pneumonia, actinomycosis, nocardiosis, malaria, infections caused by M marinum and Pasteurella species (typically after an animal bite), and as malaria prophylaxis (including multidrug-resistant P falciparum). They also have been used in combination with other medications for amebiasis, falciparum malaria, and H pylori. With its modest activity against pneumococci (same or better than macrolides) and reliable coverage of H influenzae, Chlamydophila, Legionella, and Mycoplasma organisms, doxycycline is a potential empiric monotherapy choice in mild cases of community-acquired pneumonia or in combination with beta-lactams for patients with community-acquired pneumonia and comorbidities. Doxycycline and minocycline are options in the treatment of community-onset skin and soft tissue infection due to methicillin-resistant S aureus. As discussed previously, minocycline and doxycycline are superior to tetracycline in the treatment of methicillin-resistant S aureus; doxycycline-resistant isolates are often still inhibited by minocycline. Minocycline is equally as efficacious as doxycycline for the therapy of nongonococcal urethritis and cervicitis.
Hypersensitivity reactions with fever or skin rashes are uncommon.
B. Gastrointestinal Side Effects
Diarrhea, nausea, and anorexia are common. Tetracycline administration, particularly doxycycline and minocycline, should be avoided at bedtime due to the risk of esophageal erosion.
Tetracyclines are bound to calcium deposited in growing bones and teeth, causing fluorescence, discoloration, enamel dysplasia, deformity, or growth inhibition. Therefore, tetracyclines should not be given to pregnant women, nursing women, or children under 8 years of age. The warning regarding dental staining with tetracyclines and children has existed for decades. However, children treated with doxycycline for suspected Rocky Mountain spotted fever have been found to have no dental staining, enamel hypoplasia, or tooth color differences. Consequently, certain children can likely receive doxycycline in the absence of other options.
Tetracyclines can impair hepatic function or even cause liver necrosis, particularly in the presence of preexisting liver disease.
All tetracyclines may induce photosensitization, especially in fair-skinned individuals. Minocycline induces vestibular reactions (dizziness, vertigo, nausea, vomiting), with a frequency of 35–70% associated with doses of 200 mg daily.
et al. Treatment effectiveness of azithromycin
in uncomplicated rectal and vaginal Chlamydia trachomatis infections in women: a multicenter observational study (FemCure). Clin Infect Dis. 2019;69:1946.