Tetracycline Adverse Reactions
- abdominal pain
- anorexia
- azotemia
- candidiasis
- diarrhea
- dysphagia
- elevated hepatic enzymes
- enamel hypoplasia
- eosinophilia
- erythema
- erythema multiforme
- esophageal ulceration
- esophagitis
- Fanconi syndrome
- gingivitis
- glossitis
- hepatic failure
- hepatitis
- increased intracranial pressure
- nausea/vomiting
- neutropenia
- odynophagia
- photosensitivity
- pseudotumor cerebri
- Stevens-Johnson syndrome
- teratogenesis
- tooth discoloration
Tetracycline Adverse Reactions
Benign increased intracranial pressure (pseudotumor cerebri) can occur during therapy with tetracycline and is usually reversible following discontinuation of the drug but may produce permanent sequelae. The usual clinical manifestations of pseudotumor cerebri are headache and blurred vision.
Diarrhea, nausea/vomiting, abdominal pain, and anorexia are all possible GI side effects of tetracycline. These effects occur most often following oral administration and can be alleviated by taking the drug with large amounts of fluid and avoiding dosage at bedtime. Hepatotoxicity (e.g., elevated hepatic enzymes, hepatitis, hepatic failure) should be considered. Abdominal complaints may suggest hepatotoxicity, although the incidence has been reported to be about 4.7%. Rare cases of esophagitis and esophageal ulceration have been reported in patients receiving tetracycline capsules or tablets, but not tetracycline liquids. Tetracycline-induced esophagitis is characterized by sudden onset odynophagia, retrosternal pain, and dysphagia. Risk factors include taking the medication without water and at night. Symptoms usually resolve within days to weeks after stopping the medication.
Oral or parenteral tetracycline therapy can result in oral, rectal, or vaginal candidiasis due to changes in the normal balance of microbial flora. Candidal infections are more likely to occur in debilitated patients, those taking the drug over prolonged periods, and geriatric patients. The condition usually resolves upon discontinuation of the drug.
Photosensitivity, if apparent, can appear within minutes of taking the tetracycline if the patient is exposed to direct sunlight or UV light. Warning signs, including tingling and burning of the hands, feet, and nose, may indicate latent photosensitivity. If the drug is discontinued, symptoms are usually alleviated within 1-2 days. Sunscreens seem to provide only limited protection, and a severe response may necessitate treatment with corticosteroids or antihistamines. Rashes and discolored nails have been reported. Also, tetracyclines have been associated with erythema multiforme including Stevens-Johnson syndrome (aching joints and muscles; redness, blistering, peeling of the skin).
Tooth discoloration has been seen in children who received a tetracycline antibiotic, but this reaction has also been reported in adults. Enamel hypoplasia can result. Although this is not typically thought of as teratogenesis, some references include tetracyclines in lists of teratogenic drugs. While isolated cases of major fetal malformations have been reported in offspring of mothers who received a tetracycline drug during pregnancy, analysis of the data does not support an association between these drugs and these major malformations (e.g., oral clefts, spina bifida, polydactyly). Limited data exist which support a possible risk of minor malformations (e.g., hypospadias, inguinal hernia).
Tetracycline-induced neutropenia and/or eosinophilia may occur, but generally is associated with long-term therapy. Patients should be evaluated regularly in these instances.
Nephrotoxicity and azotemia can occur, but is usually a problem only for patients with impaired renal function, in which the half-life of tetracycline is greatly increased. Lower doses may be necessary, and these patients’ renal function should be monitored before and during treatment. Fanconi syndrome has been associated with use of outdated tetracycline therapy, so shelf-life dates should be strictly adhered to. This syndrome may be due to accelerated deterioration of the antibiotic from inclusion of citric acid in the preparation.
Patients on long-term therapy with tetracyclines can develop a vitamin B deficiency, possibly as a result of the antibiotic action on the gut flora. This deficiency could have potentially serious effects, especially in geriatric patients. Vitamin B supplements may be advisable for these patients.
Tetracycline for ophthalmic use can cause eye irritation or itching and burning of the lids.
Tetracycline periodontal fibers can cause glossitis and gingivitis in less than 1% of
patients. Gingivitis is more common following fiber placement in an abscessed area. Oral candidiasis and staining of tongue rarely occurs. Discomfort on fiber placement and local erythema occurs more frequently, in approximately 10% of patients.
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