Tetracyclines are go-to, broad-spectrum antibiotics that have been pill-pushed by prescribers nationwide.
Tetracyclines (eg, minocycline, doxycycline, tetracycline)1,2 are go-to, broad-spectrum antibiotics that have been pill-pushed by prescribers nationwide. But who can blame them? Tetracyclines have a vast number of bacteria on their “hit list,” and they have numerous FDA-approved indications for treating infections, ranging from syphilis to anthrax.1
For treating these infections, the general mechanism of tetracyclines is blockage of bacterial protein synthesis. Tetracyclines have been shown to impair bacterial protein synthesis by binding to the 30 S subunit of the ribosome, thereby preventing the ability of transfer ribonucleic acid to bind to the ribosome complex to allow protein synthesis.1,2
In addition to antimicrobial activity, tetracyclines have other indications on their hit list. Current data have shown that tetracyclines can suppress inflammation, angiogenesis, and tumor proliferation.3-5 Their nonantimicrobial properties have made them the preferred agents for treating various noninfectious disease—related disease states—namely inflammation.3-5 However, tetracyclines’ true mechanism of action in treating inflammation is unclear.3-5 Experts4,5 suspect they manage inflammation by:
Due to these purported mechanisms, tetracyclines have made a lasting impact on the management of various inflammatory- related disease states.
The 2007 American Academy of Dermatology guidelines recommend minocycline or doxycycline as the preferred first-line oral agents for managing moderate to severe acne. This recommendation is based on over 20 randomized control trials suggesting that these agents were consistently effective for treating acne in affected patients. In addition, trimethoprim/sulfamethoxazole or erythromycin can be used as alternatives for patients who cannot tolerate such tetracyclines.10
The 2014 American Acne & Rosacea Society guidelines recommend lowdose doxycycline, at 40 mg once daily, for patients with rosacea—specifically patients with centrofacial erythema with papulopustular lesions. This dosage is recommended for patients who may not be adherent to topical administrations. Other tetracyclines or macrolides (eg, azithromycin) may be used as alternatives based on the clinician’s judgement. This recommendation is based on expert opinion.11
The 2012 American College of Rheumatology guidelines recommend minocycline for the treatment of rheumatoid arthritis (RA). Minocycline should be used in patients with early RA in the presence of low disease activity or in patients with moderately or highly active disease without poor prognostic factors. Minocycline can be used in both patient groups as long as they have had RA for fewer than 6 months. This recommendation is based on multiple randomized clinical studies.12
The 2015 American Dental Association guidelines for periodontitis recommend doxycycline as the preferred agent for patients with severe chronic periodontitis. Specifically, the anti-inflammatory formulation dose (40 mg once daily) is recommended. This is based on 11 randomized control trials suggesting that doxycycline is safe and effective for treating periodontitis after 3 to 9 months of daily treatment.13
Mohamed Jalloh, PharmD, is an instructor at Creighton University in Omaha, Nebraska, and a community pharmacist at Walgreens.