There is little difference in clinical response among the various tetracyclines. The selection of an agent, therefore, is based on tolerance, ease of administration, and cost. The restriction of their use in pregnancy and in patients under the age of 8 years applies to all preparations.
Two tetracyclines have sufficiently distinctive features to warrant separate mention. Doxycycline, with its longer half-life and lack of nephrotoxicity, is a popular choice for patients with preexisting renal disease or those who are at risk for developing renal insufficiency. The lack of nephrotoxicity is related mainly to biliary excretion, which is the primary route of doxycycline elimination. Doxycycline is the preferred parenteral tetracycline. Doxycycline is a potential first-line agent in the prophylaxis of anthrax after exposure. Doxycycline is the treatment of choice for the primary stage of Lyme disease in adults and children older than 8 years.
Minocycline is an effective alternative to rifampin for eradication of meningococci, including sulfonamide-resistant strains, from the nasopharynx. However, the high incidence of dose-related vestibular side effects renders it less acceptable. Although minocycline has good in vitro activity against Nocardia spp., further studies are necessary to confirm its clinical efficacy.
The tetracyclines are still the drugs of choice for treatment of cholera, diseases caused by Rickettsia and Coxiella, granuloma inguinale, relapsing fever, the chlamydial diseases (trachoma, lymphogranuloma
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