Tetracycline agents

The tetracyclines are strong chelating agents. Both the A-ring and 11,12 P-diketone systems are active sites for chelation (16). This abiUty to chelate to metals, such as calcium, results in tooth discoloration when tetracycline is administered to children (17). 

Mjcoplasmas rickettsiae chlamjdia, and protozoan parasites are also, in general, susceptible to tetracyclines (88—90) (see also Antiparasitic agents). 

A combination of amphotericin B, miconazole (16), and rifampin (17) was used to successfully cure one patient. In addition, tetracycline (7) and minocycline (18) have been recommended although their clinical efficacy have not been estabUshed. No proven therapeutic agents exist for treating A.catbamoeba infections, however, the phenothiazines, trifluoperazine [117-89-5] and chlorpromazine [50-53-3], show promise in vitro. 

The first three of these agents to be discovered, tetracycline (1) chlortetracycline (2), and oxytetracycline (3), ... 

Fig. 29. Effect of the extent of crosslinking of sulfonated cation exchangers (quantity of cross-linking agent) on diffusion coefficient of tetracycline in sorbent grains 1) SDMDMA, 2) SHMDMA, i) SEDMA, 4) Dowex-50W...

It is important to use the tetracyclines cautiously in patients witii renal function impairment, hi addition, doses greater that 2 g d can be extremely damaging to die liver. The nurse should carefully check die expiration dates of die tetracyclines before administration because degradation of the tetracyclines can occur after degradation, the agents are highly toxic to the kidneys. 

The absorption of oral iron is decreased when tlie agent is administered with antacids, tetracyclines, penicillamine, and the fluoroquinolones. When iron is administered with levothyroxine, there may be a decrease in tlie effectiveness of levothyroxine When administered orally, iron deceases the absoqition of lev-odopa. Ascorbic acid increases tlie absoqition of oral iron. Iron dextran administered concurrently with chloramphenicol increases serum iron levels. 

Oral administration of bicarbonate may decrease the absorption of ketoconazole. Increased blood levels of quinidine, flecainide, or sympatiiomimetics may occur when these agents are administered with bicarbonate There is an increased risk of crystalluria when bicarbonate is administered with the fluoroquinolones. Fbssible decreased effects of lithium, methotrexate, chlorpropamide, salicylates, and tetracyclines may occur when these drag s are administered with sodium bicarbonate. Sodium bicarbonate is not administered within 2 hours of enteric-coated drugs the protective enteric coating may disintegrate before the drug reaches the intestine. 

Oral tetracyclines that probably act as anti-inflammatory and marked immunodepressing agents. Dosages currently used are 250 mg twice daily for oxytetracycline 100 mg twice daily for minocycline 100 mg once daily for doxycycline and 400 mg for lymecycline. Therapy should be prolonged for 20 days [9]... 

Although tetracycline, doxycycline, and minocycline are the most commonly prescribed oral antibiotics for acne, erythromycin and clindamycin are appropriate second-line agents for use when patients cannot tolerate or have developed resistance to tetracycline or its derivatives.3 See Table 62-3 for antibiotic dosing guidelines. 

Parenterally administered penicillin is recommended for all stages of syphilis. Alternative agents may be used in allergic individuals and include doxycycline, minocycline, tetracycline, or erythromycin base or stearate. Some patients may not respond favorably to alternative modalities. Therefore, in patients who must be administered penicillin (i.e., patients who are pregnant or have central nervous system [CNS] involvement) or are allergic, desensitization must be performed before the drug is initiated. 

Absorption of antimicrobial agents such as fluoroquinolones and tetracyclines that can be bound by divalent and trivalent cations potentially could be compromised by administration with EN formulas containing these cations. The fluoroquinolones (e.g., levofloxacin and ciprofloxacin) have been best studied in this regard, and results of studies are not consistent. Mechanisms for an interaction between fluoroquinolones and EN formulas other than chelation by cations have been postulated.40 Some institutions hold tube feedings for 30 to 60 minutes or more before and after enteral dosages of fluoroquinolones. Because ciprofloxacin absorption has been shown to be decreased with jejunal administration, this drug probably should not be given by jejunal tube.41... 

Still among the most frequently prescribed drugs, the antibiotic tetracyclines have decreased in popularity recently due to development of bacterial resistance in the clinic. The search for improved agents goes on. 

Price, R., Gaber, B. and Lvov, Y. (2001) In-vitro release characteristics of tetracycline, khellin and nicotinamide adenine dinudeotide from halloysite a cylindrical mineral for delivery of biologically active agents. Journal of Microencapsulation, 18, 713—723. 

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. 

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