Second generation tetracycline

Systemic antibiotics are indicated for moderate-severe inflammatory acne not responding to topical treatments. Systemic antibiotics act on 1) suppression of P. acnes growth 2) inhibition of bacterial lipases 3) reduction of free fatty acids and 4) reduction of inflammation. Oxytetracycline and its derivatives are the most commonly used oral antibiotics. Second-generation tetracyclines such as minocycline, doxy-cycline and lymecycline present longer half-lives, enhanced bacterial activity and lower... 

Tetracyclines have been marketed since 1984, and, since discovery, some first-generation tetracyclines such as tetracycline, oxytetracycline, and chlorotetracychne have been extensively used in livestock and aquaculture, besides clinical use by humans. For human use, the second-generation tetracyclines doxycycline and minocycline have been prescribed to a great extent, and indeed prescription of the latter has steadily increased in the United States over the 2003-2005 period (Fig. 1.7). However, each of these tetracyclines is less than 0.5% of all the other 200 most prescribed dmgs. Tetracyclines are also prescribed to a good extent in several European countries (Fig. 1.6), with the exception of Italy and Denmark where per capita prescriptions are quite minimal, that is, <25 prescriptions per 1000 inhabitants (Molstad et ah, 2000). They are also widely used in animal husbandry where daily therapeutic doses of 40 mg tetracycline kg liveweight are typical (Kilhne et al., 2000). 

The future prospects of a possible second generation tetracyclines are almost written on the wall provided the meaningful and fiuitful clinical trials of the ongoing glycylcyclines do emerge both favourable pharmacokinetic and toxicological profiles for such medicinal compounds in the near future. 

Moxifloxacin hydrochloride was approved for the peroral treatment of AECB, CAP and ABS, and is also available as an infusion solution for the sequential treatment of CAP. In 2004, it was additionally approved by the FDA as the first intravenously and perorally administrable antibiotic for treating CAP, which is caused by multidrug-resistant S. pneumoniae (MDRSP). MDRSP is understood to include those strains of S. pneumoniae that are resistant to two or more of the following classes of antibiotics penicillins and second-generation cephalosporins such as cefuroxime, macrolides, tetracyclines and trimethoprim/sulfamethoxazole. 

COPD exacerbations. Therefore, in exacerbation treatment with antibiotics is justified when the patient has at least two of three features of increased dyspnea, increased sputum volume, and sputum pu-rulence. Antibiotic choice will depend on local experience derived from local bacteriological sensitivity data. Older, less costly compounds such as tetracycline, doxycycline, amoxicillin, erythromycin, cefaclor etc. are often as effective as newer, more expensive ones. If resistant organisms are suspected or when the severity of the patients clinical condition puts them at high-risk of treatment failure, a second or third generation cephalosporin, fluoroquinolone, newer macrolide or broad-spectrum penicillin may be preferred. In cases of recurrent infection prolonged courses of antibiotics continuous or intermittent, may be useful. 

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