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(teh-truh-SIGH-kleen HIGH-droe-KLOR-ide)
Achromycin, Actisite, Panmycin, Sumycin 250, Sumycin 500, Sumycin Syrup, Tetracap, Tetracyn, Tetracyn 500, Tetralan Syrup, Topicycline,  Apo-Tetra, Jaa Tetra, Novo-Tetra, Nu-Tetra, Tetracyn
Class: Antibiotic/Tetracycline

 Action Inhibits bacterial protein synthesis.

 Indications Treatment of infections due to susceptible strains of gram-positive and gram-negative bacteria; treatment of Rickettsia, Mycoplasma pneumonia; chlamydial infections including treatment of trachoma; treatment of susceptible infections when penicillins are contraindicated; treatment of acute intestinal amebiasis. Ophthalmic: Prophylaxis of ophthalmia neonatorium; treatment of superficial ocular infections due to susceptible organisms. Topical: Treatment of acne vulgaris; infection prophylaxis in minor cuts, wounds, burns, and abrasions. Treatment use(s): Treatment of acne.

 Contraindications Hypersensitivity to tetracyclines or any component; Ophthalmic use is contraindicated in epithelial herpes simplex keratitis, fungal disease of ocular structure and after removal of corneal compound.

 Route/Dosage

ADULTS: PO 1–2 g daily in 2–4 equal doses. CHILDREN > 8 YR: PO 25–50 mg/kg in 4 equal doses.

Acute Gonococcal Infection

ADULTS: PO 1.5 g initially, then 500 mg q 6 hr to total 9 g.

Syphilis

ADULTS: PO 30–40 g in equally divided doses over 10–15 days.

Chlamydia

ADULTS: PO 500 mg qid for at least 7 days.

Ocular Infections

ADULTS: Ophthalmic acute infections: 1–2 gtt q 15–30 min initially or 0.5-inch ointment q 3–4 hr; moderate infections: 1–2 gtt 4–6 times daily or 0.5-inch ointment bid-tid.

Ophthalmia Neonatorium Prevention

NEONATES: Ophthalmic 0.5-inch ointment to eyes once.

Acne Vulgaris

ADULTS: Topical Apply am and pm 1–4 times daily to affected area. PO 125–500 mg once daily.

 Interactions

Digoxin: May increase digoxin serum levels. Food, dairy products, iron salts, antacids (containing aluminum, zinc, calcium, magnesium), bismuth salts, activated charcoal, divalent or trivalent cations: May decrease oral absorption of tetracycline. Lithium: May see altered lithium levels; monitor therapy. Methoxyflurane: Increased potential for nephrotoxicity exists; do not use together. Oral contraceptives: May reduce effect of oral contraceptives. Penicillins: May interfere with bactericidal action of penicillins. Zinc salts, urinary alkalinizers: May decrease serum tetracycline levels.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Pericarditis. DERM: Rash; urticaria; photosensitivity. GI: Diarrhea; nausea; vomiting; abdominal pain or discomfort; anorexia; bulky, loose stools; sore throat; glossitis; anorexia. GU: Increased BUN. HEMA: Hemolytic anemia; thrombocytopenia; neutropenia. HEPA: Increased liver function test results. OTHER: Hypersensitivity, including anaphylaxis; local reactions (eg, stinging or burning sensation with topical application).

 Precautions

Pregnancy: Avoid during pregnancy. Lactation: Excreted in breast milk. Children: Avoid in children < 8 yr because abnormal bone formation and discoloration of teeth may occur. Outdated product: Do not use since degradation products are highly nephrotoxic. Ophthalmic use: May retard corneal epithelial healing. Pseudotumor cerebri (benign intracranial hypertension): Has been reported in adults. Usual manifestations are headache and blurred vision. Renal impairment: Excessive accumulation may occur in patients with renal impairment, resulting in possible liver toxicity; dosage reduction may be required. Superinfection: Prolonged use may result in bacterial or fungal overgrowth.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer oral form with full glass of water 1 hr before or 2 hr after meals to enhance absorption. Give at least 1 hr before bedtime to prevent esophagitis.
  • Do not expose drug to light or heat.
  • Store suspension form in refrigerator.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Assess baseline liver function test results and blood chemistry as tetracycline may cause LFT results and BUN to increase.
  • Observe patient for anaphylactic reaction after administration.

OVERDOSAGE: SIGNS & SYMPTOMS
  Nausea, vomiting, headache, increased intracranial pressure, skin pigmentation

 Patient/Family Education

  • Tell patient to take oral doses with full glass of water 1 hr before or 2 hr after meals to enhance absorption.
  • Alert patient to potential side effects, such as photosensitivity and nausea, vomiting and diarrhea.
  • Advise patient to avoid dairy products, antacids and iron supplements while taking this drug.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Instruct patient to watch for signs of superinfection.
  • Notify patient that topical use may result in burning sensation. Explain that if this persists or if infection occurs, physician should be notified and use should be discontinued.
  • Explain that topical medication may stain clothing.
  • Demonstrate proper administration technique for ophthalmic installation and have patient provide return demonstration.
  • Instruct patient to discard old oral tetracycline products as the product becomes toxic when outdated.

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