Antimicrobial therapy tetracyclines

Systemic or topical antimicrobial therapy (tetracycline, minocycline, erythromycin, at low dose) is used over months (response begins after 2 months). Bacterial resistance is not a problem benefit is due to suppression of bacterial lipolysis of sebum, which generates inflammatory fatty acids. Raised intracranial pressure with loss of vision has occurred with tetracycline used thus. 

Finland, M. Twenty-fifth anniversary of the discovery of Aureomycin the place of the tetracyclines in antimicrobial therapy. Clin. Pharmacol. Ther. 1974, 15, 3-8. 

Systemic therapy with a variety of (3-lactams, macro-lides and lincosamides (clindamycin) has been the cornerstone of skin infection therapy for many years [17]. However, topical antibiotics can play an important role in both treatment and prevention of many primary cutaneous bacterial infections commonly seen in the dermatological practice [18], Indeed, while systemic antimicrobials are needed in the complicated infections of skin and skin structure, the milder forms can be successfully treated with topical therapy alone [18], The topical agents used most often in the treatment of superficial cutaneous bacterial infections are tetracyclines, mupirocin, bacitracin, polymyxin B, and neomycin. 

Many antimicrobial agents have similar pharmacokinetic properties when given orally or parenterally (ie, tetracyclines, trimethoprim-sulfamethoxazole, quinolones, chloramphenicol, metronidazole, clindamycin, rifampin, linezolid and fluconazole). In most cases, oral therapy with these drugs is equally effective, is less costly, and results in fewer complications than parenteral therapy. 

Additional studies, such as those conducted by the US Institute of Medicine Report (lOM) in 1988, also attempted to determine the impact of drug usage in food-producing animals on antimicrobial resistance of human pathogens, using penicillin and tetracycline on Salmonella as a model. The authors of this study attempted to describe the extent to which transfer of resistance factors occurred between human and animals and to define whether the risk to human therapy was enough to outweigh the benefits of a cost-effective food supply. The result of the lOM Report was that the information available to answer the question was insufficient. 

Amlnocyclitols in general, and spectinomycin in particular, are effective in no more than half the patients with NGU, an observation that correlates with the fact that U. urealyticum is susceptible but C. trachomatis is not. Conversely, sulfonamide therapy is successful in chlamydial NGU, but not in NGU associated with U. urealyticum. The differential response to sulfisoxazole or spectinomycin has been used to differentiate chlamydial from ureaplasmal NGU, and a combination of these two agents deserves a clincial trial as an alternative to the tetracyclines. C. trachomatis and U. urealyticum are individually susceptible to several other antimicrobial agents,but all are clinically ineffective or have not been subjected to controlled studies. 

Resistant strains of P. acnes are emerging that may respond to jndicions nse of retinoids in combination with antibiotics. Commonly nsed topical antimicrobials in acne inclnde erythromycin, clindamycin (Cleocin-t), and benzoyl peroxide and antibiotic-benzoyl peroxide combinations (Benzamycin, Benzaclin, others). Other antimiaobials nsed in treating acne inclnde sulfacetamide (Klaron), sulfacetamide/sulfur combinations (Snlfacet-R), metronidawie (Metrocream, Metro-Gel, noritate), and azelaic acid (Azelex). Systemic therapy is prescribed for patients with more extensive disease and acne that is resistant to topical therapy. Effective agents inclnde tetracycline (snmycin, others), minocycline (MINO-CIN, others), erythromycin (ERYC, others), clindamycin (CLEOCIN), and trimethoprim-sulfamethoxazole (bactrim, others). Antibiotics nsnally are administered twice daily, and doses are tapered after control is achieved. 

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