Tetracycline Indications and Dosage
- acne rosacea
- acne vulgaris
- Actinomyces israelii
- actinomycosis
- amebiasis †
- anthrax
- anthrax prophylaxis †
- Bacillus anthracis
- bacterial conjunctivitis
- Balantidium coli
- Bartonella bacilliformis
- bartonellosis
- bejel †
- biliary tract infections †
- Bordetella pertussis
- Borrelia burgdorferi
- Borrelia recurrentis
- bronchitis
- Brucella sp.
- brucellosis
- Burkholderia mallei
- Burkholderia pseudomallei
- Calymmatobacterium granulomatis
- Campylobacter fetus
- cervicitis
- chancroid
- Chlamydia psittaci
- Chlamydia trachomatis
- chlamydial conjunctivitis
- cholera †
- Clostridium perfringens
- Clostridium tetani
- Coxiella burnetii
- duodenal ulcer †
- Entamoeba histolytica
- enterocolitis †
- Francisella tularensis
- Fusobacterium fusiforme
- gastric ulcer †
- gonorrhea
- granuloma inguinale
- Haemophilus ducreyi
- Haemophilus influenzae (beta-lactamase negative)
- Haemophilus influenzae (beta-lactamase positive)
- Helicobacter pylori
- Legionella pneumophila
- Legionnaire’s disease †
- Leptospira sp.
- Leptotrichia buccalis
- Listeria monocytogenes
- lower respiratory tract infections
- Lyme disease †
- lymphogranuloma venereum
- malaria †
- murine typhus
- Mycobacterium fortuitum
- Mycobacterium marinum
- Mycoplasma hominis
- Mycoplasma pneumoniae
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Nocardia sp.
- non-gonococcal urethritis (NGU)
- ophthalmia neonatorum prophylaxis
- otitis media
- Pasteurella multocida
- periodontitis
- pharyngitis
- pinta †
- plague
- plague prophylaxis
- Plasmodium falciparum
- pneumonia
- proctitis
- Propionibacterium acnes
- Propionibacterium propionicum
- psittacosis
- Q fever
- relapsing fever
- Rickettsia akari
- Rickettsia prowazekii
- Rickettsia rickettsii
- Rickettsia tsutsugamushi
- Rickettsial pox
- Rocky Mountain spotted fever
- Shigella sp.
- shigellosis
- sinusitis
- skin and skin structure infections
- Spirillum minus
- Streptobacillus moniliformis
- syphilis
- Treponema pallidum
- tularemia
- upper respiratory tract infections
- Ureaplasma urealyticum
- urinary tract infection (UTI)
- Vibrio cholerae
- Vibrio parahaemolyticus
- yaws
- Yersinia enterocolitica
- Yersinia pestis
† non-FDA-approved indication
Tetracycline Indications...Dosage
The following organisms are generally considered susceptible to tetracycline in vitro: Actinomyces israelii; Bacillus anthracis; Balantidium coli; Bartonella bacilliformis; Bordetella pertussis; Borrelia burgdorferi; Borrelia recurrentis; Brucella sp.; Burkholderia mallei; Burkholderia pseudomallei; Calymmatobacterium granulomatis; Campylobacter fetus; Chlamydia psittaci; Chlamydia trachomatis; Clostridium perfringens; Clostridium tetani; Coxiella burnetii; Entamoeba histolytica; Francisella tularensis; Fusobacterium fusiforme; Haemophilus ducreyi; Haemophilus influenzae (beta-lactamase negative); Haemophilus influenzae (beta-lactamase positive); Helicobacter pylori; Legionella pneumophila; Leptospira sp.; Leptotrichia buccalis; Listeria monocytogenes; Mycobacterium fortuitum; Mycobacterium marinum; Mycoplasma hominis; Mycoplasma pneumoniae; Neisseria meningitidis; Nocardia sp.; Pasteurella multocida; Plasmodium falciparum; Propionibacterium acnes; Propionibacterium propionicum; Rickettsia akari; Rickettsia prowazekii; Rickettsia rickettsii; Rickettsia tsutsugamushi; Shigella sp.; Spirillum minus; Streptobacillus moniliformis; Treponema pallidum; Ureaplasma urealyticum; Vibrio cholerae; Vibrio parahaemolyticus; Yersinia enterocolitica; Yersinia pestis.
For the treatment of severe actinomycosis caused by Actinomyces israelii:
Oral dosage:
Adults: 1-2 g/day PO given in 2-4 divided doses for 12-18 months after 3-4 weeks of penicillin G.
Children > 8 years of age: 25-50 mg/kg/day PO given in 2-4 divided doses for 12-18 months after 3-4 weeks of penicillin G.
For the treatment of Lyme disease † caused by Borrelia burgdorferi:
NOTE: Doxycycline may be the preferred tetracycline for the treatment of Lyme disease.
Oral dosage:
Adults: 500 mg PO every 6 hours for 10-30 days.
Children > 8 years of age: 25-50 mg/kg/day PO given in 2-4 divided doses.
For the treatment of chronic bacterial conjunctivitis caused by susceptible organisms:
Oral dosage:
Adults: The recommended dosage is 250 mg PO four times per day for 10-21 days.
For the treatment of relapsing fever due to Borrelia recurrentis:
Oral dosage:
Adults: 250-500 mg PO every 6 hours or 500-1000 mg PO every 12 hours.
For the treatment of non-gonococcal urethritis (NGU), cervicitis, or proctitis due to Chlamydia trachomatis in the nonpregnant patient:
Oral dosage:
Adults: 500 mg PO every 6 hours for 7 days.
For the treatment of chlamydial conjunctivitis caused by Chlamydia trachomatis including trachoma and inclusion conjunctivitis:
NOTE: Topical ophthalmic therapy alone is usually inadequate for the treatment of trachoma or inclusion conjunctivitis and is generally used as an adjunct to oral anti-infective therapy.
Oral dosage:
Adults and children > 8 years: 250 mg PO four times per day with or without topical tetracyclines for 3 weeks.
Ophthalmic dosage:
Adults and children: Instill two drops of ophthalmic solution in each eye 2-4 times per day. Continue for 1 to 2 months or longer, or use 1% ophthalmic ointment 3-4 times per day for 30 days.
For the treatment of lymphogranuloma venereum caused by Chlamydia sp. or granuloma inguinale caused by Calymmatobacterium granulomatis:
Oral dosage:
Adults: 500 mg PO every 6 hours for 21 days.
For the treatment of psittacosis caused by Chlamydia psittacosis:
Oral dosage:
Adults: 500-750 mg PO every 6 hours for 1-2 weeks.
For the treatment of tularemia caused by Francisella tularensis or enterocolitis † caused by Shigella sp.:
Oral dosage:
Adults: 1-2 g/day PO in 2-4 divided doses.
Children > 8 years: 25-50 mg/kg/day PO in 2-4 divided doses.
For the treatment cutaneous anthrax infection caused by susceptible strains of Bacillus anthracis:
NOTE: Recommendations for pregnant and immunosuppressed persons are the same as for non-pregnant or non-immunosuppressed persons.
Oral dosage:
Adults: In vitro testing suggests tetracycline 500 mg PO every 6 hours for 60 days could be substituted for doxycycline. Although previous guidelines suggested treatment for 7-10 days, in the setting of bioterrorism the recommended treatment duration is 60 days, given the presumed exposure to the primary aerosol. Topical treatment is not useful.
Children † : In vitro testing suggests tetracycline 25-50 mg/kg/day PO given in 2-4 divided doses for 60 days could be substituted for doxycycline. Although previous guidelines suggested treatment for 7-10 days, in the setting of bioterrorism the recommended treatment duration is 60 days, given the presumed exposure to the primary aerosol. Topical treatment is not useful. The American Academy of Pediatrics recommends that tetracycline not be used in children < 8 years; however, the risk of serious infection following anthrax exposure supports the use of tetracycline if antibiotic susceptibility testing, exhaustion of drug supplies or allergic reactions preclude the use of ciprofloxacin or amoxicillin.
For anthrax prophylaxis † following exposure to susceptible strains Bacillus anthracis regardless of the route of exposure:
Oral dosage:
Adults: In vitro testing suggests tetracycline 500 mg PO every 6 hours for 60 days could be substituted for doxycycline. The risk of serious infection following anthrax exposure supports the use of tetracycline in pregnant women if antibiotic susceptibility testing, exhaustion of drug supplies, or allergic reactions preclude the use of ciprofloxacin or amoxicillin.
Children † : In vitro testing suggests 25-50 mg/kg/day PO given in 2-4 divided doses for 60 days could be substituted for doxycycline. The American Academy of Pediatrics recommends that tetracycline not be used in children < 8 years; however, the risk of serious infection following anthrax exposure supports the use of tetracycline if antibiotic susceptibility testing, exhaustion of drug supplies or allergic reactions preclude the use of ciprofloxacin or amoxicillin.
For the treatment of upper respiratory tract infections (e.g. otitis media, sinusitis, pharyngitis) caused by Haemophilus influenzae (beta-lactamase negative), Haemophilus influenzae (beta-lactamase positive), or Klebsiella sp.:
Oral dosage:
Adults: 1-2 g/day PO given in 2-4 divided doses.
Children > 8 years of age: 25-50 mg/kg/day PO given in 2-4 divided doses.
For the treatment of biliary tract infections † caused by susceptible organisms:
Oral dosage:
Adults: 1-2 g/day PO given in 2-4 divided doses.
Children > 8 years of age: 25-50 mg/kg/day PO given in 2-4 divided doses.
For the treatment of skin and skin structure infections due to susceptible strains of Escherichia coli † , Proteus sp. † , Staphylococcus aureus, Staphylococcus epidermidis † , Streptococcus pneumoniae or Streptococcus pyogenes † :
NOTE: Tetracyclines are not the drugs of choice in the treatment of any type of staphylococcal infection.
Oral dosage:
Adults: 1-2 g/day PO given in 2-4 divided doses.
Children > 8 years of age: 25-50 mg/kg/day PO given in 2-4 divided doses.
For the treatment of bacterial urinary tract infection (UTI) caused by Klebsiella sp., E. coli † , Enterobacter aerogenes † , or Proteus sp.:
Oral dosage:
Adults: 1-2 g/day PO given in 2-4 divided doses.
Children > 8 years of age: 25-50 mg/kg/day PO given in 2-4 divided doses.
For the treatment of extraintestinal amebiasis † caused by Entamoeba histolytica in combination with metronidazole:
Oral dosage:
Adults: 1-2 g/day PO given in 2-4 divided doses.
Children > 8 years of age: 25-50 mg/kg/day PO given in 2-4 divided doses.
For the treatment of bejel † , yaws, and pinta † caused by Treponema pallidum:
NOTE: penicillin G is the drug of choice for treatment of bejel, yaws, and pinta caused by Treponema pallidum.
Oral dosage:
Adults and children > 8 years of age: 25 mg/kg/day PO given in 2-4 divided doses for 10-14 days.
For the prevention of acute exacerbations of chronic bronchitis:
Oral dosage:
Adults: 250-500 mg PO every 6 hours.
For the treatment of lower respiratory tract infections (e.g. pneumonia) due to Mycoplasma pneumoniae, Haemophilus influenzae (beta-lactamase negative), Haemophilus influenzae (beta-lactamase positive), or Klebsiella sp.:
Oral dosage:
Adults: 250-500 mg PO three times per day.
For the treatment of acne rosacea:
Oral dosage:
Adults and adolescents: Doses of 250-1500 mg/day PO have been used.
For the treatment of inflammatory acne vulgaris:
Oral dosage:
Adults and adolescents: Initially, 125-250 mg PO every 6 hours for 1-2 weeks, then decrease slowly to 125-500 mg PO per day or every other day.
For the treatment of Rocky Mountain spotted fever, Q fever, murine typhus, Rickettsial pox, and tick-bite fever caused by Rickettsia sp.:
Oral dosage:
Adults: 1-2 g/day PO given in 2-4 divided doses.
For the treatment of bartonellosis due to Bartonella bacilliformis:
Oral dosage:
Adults: 250-500 mg PO every 6 hours or 500-1000 mg PO every 12 hours.
For the treatment of brucellosis caused by Brucella sp. in combination with streptomycin:
Oral dosage:
Adults: Tetracycline 500 mg PO every 6 hours for 3 weeks in combination with streptomycin 1 g IM twice daily for the first week, then streptomycin 1 g IM once daily for the second week.
For the treatment of chancroid caused by Haemophilus ducreyi:
Oral dosage:
Adults: 250-500 mg PO every 6 hours or 500-1000 mg PO every 12 hours.
For the treatment of Legionnaire’s disease † :
Oral dosage:
Adults: 250-500 mg PO every 6 hours or 500-1000 mg PO every 12 hours.
For the treatment of plague in a mass casualty setting following exposure to Yersinia pestis:
NOTE: Doxycycline is the treatment of choice for plague in the mass casualty setting. Tetracycline should not be used in pregnant women.
Oral dosage:
Adults: The recommended dose is 1000 mg PO every 6 hours for 10 days. If antibiotic susceptibility testing allows, oral doxycycline, ciprofloxacin, or chloramphenicol could be used as alternatives.
Children > 8 years: The recommended dose is 5 mg/kg PO every 6 hours for 10 days. If antibiotic susceptibility testing allows, oral doxycycline, ciprofloxacin, or chloramphenicol could be used as alternatives.
For plague prophylaxis following exposure to Yersinia pestis:
NOTE: Doxycycline is the treatment of choice for plague prophylaxis. Tetracycline should not be used in pregnant women.
Oral dosage:
Adults: The recommended dose is 1000 mg PO every 6 hours for 7 days. If antibiotic susceptibility testing allows, oral doxycycline, ciprofloxacin, or chloramphenicol could be used as alternatives.
Children > 8 years: The recommended dose is 5 mg/kg PO every 6 hours for 7 days. If antibiotic susceptibility testing allows, oral doxycycline, ciprofloxacin, or chloramphenicol could be used as alternatives.
For the treatment of shigellosis † :
Oral dosage:
Adults: 2.5 g PO as a single dose.
For the treatment of uncomplicated gonorrhea caused by Neisseria gonorrhoeae in nonpregnant patients:
Oral dosage:
Adults: NOTE: The CDC states that tetracyclines used alone are not adequate therapy for the treatment of gonorrhea. Tetracyclines can be used, however, in conjunction with gonococcal regimens for the presumptive treatment of coexisting chlamydial infections. The manufacturer states that uncomplicated gonorrhea may be treated with tetracycline 1.5 g PO initially, then 500 mg PO every 6 hours for 4 days.
For prevention of ophthalmia neonatorum (i.e., ophthalmia neonatorum prophylaxis) due to Neisseria gonorrhoeae:
Ophthalmic dosage:
Neonates: 1-2 drops of 1% ophthalmic solution into each eye as soon as possible after delivery or apply a ribbon of 1% ophthalmic ointment approximately 0.5-2 cm in length to the lower conjunctival sac. Treat no later than 1 hour after birth. Use a new bottle or tube for each infant.
For the treatment of syphilis:
- for the treatment of primary or secondary syphilis (caused by Treponema pallidum) in nonpregnant, penicillin-allergic patients:
Oral dosage:
Adults and adolescents: The CDC recommends 500 mg PO four times per day for 14 days.
- for the treatment of early or late latent syphilis (caused by Treponema pallidum) in nonpregnant, penicillin-allergic patients:
Oral dosage:
Adults and adolescents: The CDC recommends 500 mg PO four times per day for 2 weeks in early latent disease (less than 1 year duration) and for 4 weeks in late latent disease (greater than 1 years duration).
- for the treatment of tertiary syphilis (gumma or cardiovascular syphilis but not neurosyphilis) in nonpregnant, penicillin-allergic patients:
Oral dosage:
Adults and adolescents: The CDC recommends 500 mg PO four times per day for 4 weeks.
For the treatment of superficial ophthalmic infections:
Ophthalmic dosage:
Adults and children: Instill 1-2 drops of 1% ophthalmic solution in each eye 2-4 times per day or more often, depending on severity of infection. Or apply a small quantity of 1% ophthalmic ointment.
For use in infection prophylaxis for minor skin abrasions and treatment of superficial infections caused by susceptible organisms:
Topical dosage:
Adults and children: Apply topical 3% ointment to infected area 1-5 times daily.
For adjunct treatment to scaling and root planing for reduction of pocket depth and bleeding in patients with periodontitis:
Periodontal dosage:
Adults: Insert fibers into the periodontal pocket until the pocket is filled. Fibers are left in pocket for 10 days, then all fibers should be removed. Replace fibers if lost before 7 days.
For the treatment of infection due to Helicobacter pylori associated with gastric ulcer † or duodenal ulcer † :
NOTE: Tetracycline is most frequently used in four-drug regimens for H. pylori gastrointestinal infections as suggested by the American College of Gastroenterology (ACG) and as detailed below. However, the ACG notes that triple-drug regimens (e.g., non-tetracycline-containing regimens) may improve patient compliance and H. pylori eradication rates.
NOTE: H. pylori resistance is rare with tetracycline.
NOTE: Bismuth preparations, some antimicrobials, and some PPIs suppress H.pylori. Ingestion of these substances within four (4) weeks prior to performing urease or breath-tests for H. pylori detection may lead to false negative results. In the four weeks prior to performing the test, the patient must avoid the use of agents that are known to suppress H. pylori.
- tetracycline in combination with bismuth subsalicylate, metronidazole, and an H2-antagonist:
Oral dosage:
Adults: Two weeks of antimicrobial therapy with tetracycline 500 mg PO four times daily in combination with metronidazole 250 mg PO four times daily, bismuth subsalicylate 525 mg four times daily; in conjunction with 4 weeks of acid-suppression therapy with an H2-antagonist. This four-drug regimen is an acceptable treatment alternative suggested by the ACG guidelines for managing H. pylori infection. Clinical efficacy was originally established in a clinical trial of tetracycline, metronidazole, and bismuth subsalicylate and ranitidine versus ranitidine monotherapy. The recurrence rates of duodenal and gastric ulcers were significantly lower in patients receiving quadruple-drug therapy compared to ranitidine therapy alone.
Children: Not recommended.
- in combination with bismuth subsalicylate, metronidazole, and a proton pump inhibitor (PPI):
Oral dosage:
Adults: Two weeks of antimicrobial therapy with tetracycline 500 mg PO four times daily in combination with metronidazole (500 mg PO three times daily), bismuth subsalicylate (525 mg four times daily); and in conjunction with 4 weeks of acid-suppression therapy with once daily PPI therapy (e.g.,
lansoprazole 30 mg PO once daily or omeprazole 20 mg PO once daily). This four-drug regimen is an acceptable treatment alternative suggested by the ACG guidelines for managing H. pylori infection. Higher doses of metronidazole are used in this regimen (1500 mg/day compared to the 1000 mg/day used in Helidac® therapy) to reduce the risk of metronidazole resistance, which is increasing in the US.
Children: Not recommended.
For the treatment of malaria † due to chloroquine-resistant Plasmodium falciparum in combination with quinine sulfate:
Oral dosage:
Adults: 250 mg PO four times per day for 7 days.
Children > 8 years: 20 mg/kg/day PO divided in 4 doses for 7 days.
For the treatment of cholera † :
Oral dosage:
Adults: 500 mg PO every 6 hours for 3 days (12 doses total) in conjunction with fluid and electrolyte replacement.
Children: 12.5 mg/kg (up to 500 mg) PO every 6 hours for 3 days (12 doses total) in conjunction with fluid and electrolyte replacement.
Maximum Dosage Limits:
- Adults: 4 g/day PO.
- Elderly: 4 g/day PO.
- Adolescents: Maximum dosage information is not available. Do not exceed adult dosage.
- Children > 8 years: Maximum dosage information is not available. Do not exceed adult dosage.
- Children <= 8 years: Not recommended.
Patients with hepatic impairment:
Dose adjustment of tetracycline may be required in patients with hepatic impairment due to potential for reduced excretion and a prolonged half-life.
Patients with renal impairment:
CrCl >= 90 ml/min: no dosage adjustment needed.
CrCl 51-90 ml/min: extend dosing interval to every 8-12 hours.
CrCl 10-50 ml/min: extend dosing interval to every 12-24 hours.
CrCl < 10 ml/min: extend dosing interval to every 24 hours.
† non-FDA-approved indication
Related entries
Monthly Archives
Syndicate
Allergies
