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Doxycycline Revisited

Doxycycline Revisited Abstract Although several new antibiotics have recently become available, in several clinical instances conventional antibiotics may be equally efficacious at a considerably lower cost. In today's era of cost containment, it is particularly relevant to revisit older, inexpensive antibiotics to reexplore their role in the face of the emergence of resistant microorganisms and competition from newer agents. Doxycycline is one such antibiotic. It is an inexpensive, broad-spectrum antimicrobial agent that remains the drug of first choice for several infections. In addition, it can be used for a variety of other indications. Adverse effects are infrequent and relatively minor. While interactions occur with several medications, none of these interactions has significant adverse consequences. Arch Intern Med. 1997;157:1421-1428 References 1. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States . JAMA. 1995;273:241-242.Crossref 2. Joshi N, Milfred D. The use and misuse of new antibiotics: a perspective . Arch Intern Med. 1995; 155:569-577.Crossref 3. Duggar BM. Aureomycin: product of continuing search for new antibiotic . Ann N Y Acad Sci. 1948;51:177.Crossref 4. Finland M. Twenty-fifth anniversary of the discovery of Aureomycin: the place of the tetracyclines in antimicrobial therapy . Clin Pharmacol Ther. 1974;15:3-8. 5. Jones M, Comer JB, Cunha BA. Tetracyclines . In: Ristuccia AM, Cunha BA, eds. Antimicrobial Therapy . New York, NY: Raven Press; 1948:219-234. 6. Barza M, Brown RB, Shanks C, Gamble C, Weinstein L. Relation between lipophilicity and pharmacological behavior of minocycline, doxycycline, tetracycline, and oxytetracycline in dogs . Antimicrob Agents Chemother. 1975;8:713-720.Crossref 7. Barza M, Schiefe RT. Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics, I: tetracyclines . Am J Hosp Pharm. 1977; 34:49-57. 8. Connamacher RH, Mandel HG. Binding of tetracycline to the 30 S ribosomes and to polyuridylic acid . Biochem Biophys Res Commun. 1965;20:98.Crossref 9. Maxwell IH. Studies of the binding of tetracycline to ribosomes in-vitro . Mol Pharmacol. 1968; 4:25-37. 10. Suarez G, Nathans D. Inhibition of aminoacyl-tRNA binding to ribosomes by tetracycline . Biochem Biophys Res Commun. 1965;18:743.Crossref 11. Day LE. Tetracycline inhibition of cell-free protein synthesis, II: effect of the binding of tetracycline to the components of the system . J Bacteriol. 1966;92:197-203. 12. Pato ML. Tetracycline inhibits propagation of deoxyribonucleic acid replication and alters membrane properties . Antimicrob Agents Chemother. 1977;11:318-323.Crossref 13. Kucers A, Bennett NM. The Use of Antibiotics. 4th ed. Philadelphia, Pa: JB Lippincott; 1987: 979-1044. 14. Benveniste R, Davies J. Mechanisms of antibiotic resistance in bacteria . Annu Rev Biochem. 1973;42:471-506.Crossref 15. Bread NS Jr, Armentrout SA, Weisberger AS. Inhibition of mammalian protein synthesis by antibiotics . Pharmacol Rev. 1969;21:213-245. 16. Korkelia J. Antianabolic effect of tetracyclines . Lancet. 1971;1:974-975.Crossref 17. Saivin S, Houin G. Clinical pharmacokinetics of doxycycline and minocycline . Clin Pharmacokinet. 1988;15:355-366.Crossref 18. Davis CM, Vandersarl JV, Kraus EW. Tetracycline inequivalence: the importance of 96-hour testing . Am J Med Sci. 1973;265:69-74.Crossref 19. Meyer MC, Dann RE, Whyatt PL, Slywka GW. The bioavailability of sixteen tetracycline products . J Pharmacokinet Biopharm. 1974;2:287-297.Crossref 20. Saux MC, Mosser J, Pontagnier H, Leng B. Pharmacokinetics of doxycycline pylophosphate (PPD), hydrochloride (CHD) and base (DB) . Eur J Drug Metab Pharmacokinet. 1981;6:3-10.Crossref 21. Schreiner A, Digranes A. Pharmacokinetics of lime-cycline and doxycycline in serum and suction blister fluid . Chemotherapy. 1985;31:261-265.Crossref 22. Malmborg AS. Bioavailability of doxycycline monohydrate: a comparison with equivalent doses of doxycycline hydrochloride . Chemotherapy. 1984;30:76-80.Crossref 23. Musher DM, Minuth JN, Thorsteinsson SB, Holmes T. Effectiveness of achievable urinary concentrations of tetracyclines against 'tetracycline resistant' pathogenic bacteria . J Infect Dis. 1975;131( (suppl) ):S40-S44.Crossref 24. MacColloch CD, Richardson RA, Allwood GK. The penetration of doxycycline, oxytetracycline and minocycline into sputum . N Z Med J. 1974;80:300-302. 25. Brihmer C, Brundin J. Levels of ampicillin and doxycycline in human oviduct mucosa and serum . Acta Obstet Gynecol Scand. 1983;62:231-234.Crossref 26. Brihmer C, Brundin J. Doxycycline in human oviduct mucosa and plasma 24-30 hours after an oral dose of 100 mg . Acta Obstet Gynecol Scand. 1985;64:529-530.Crossref 27. Whelton A, Blanco LJ, Carter CG, et al. Therapeutic implications of doxycycline and cephalothin concentrations in female genital tract . Obstet Gynecol. 1980;55:28-32.Crossref 28. Blanchard P, Rudhardt M, Fabre J. Behaviour of doxycycline in the tissues . Chemotherapy. 1975; 21:8-18.Crossref 29. Yim C, Flynn NN, Fitzgerald TF. Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis . Antimicrob Agents Chemother. 1985;28:347-348.Crossref 30. Andersson H, Alestig K. The penetration of doxycycline into CSF . Scand J Infect Dis Suppl. 1976; 9:17-19. 31. MacDonald H, Kelly RG, Allen AS, et al. Pharmacokinetic studies on minocycline in man . Clin Pharmacol Ther. 1973;14:852-861. 32. Houin G, Brunner F, Nebout T, et al. The effects of chronic renal insufficiency on the pharmacokinetics of doxycycline in man . Br J Clin Pharmacol. 1983;16:245-252.Crossref 33. Whelton A, Schach von Wittenau M, Twomey TM, Walker WG, Bianchine JR. Doxycycline pharmacokinetics in the absence of renal function . Kidney Int. 1974;5:365-371.Crossref 34. Letteri JM, Miraflor F, Tablante V, Siddiqi S. 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Prophylactic antibiotic for suction curettage abortion: results of a clinical controlled trial . Am J Obstet Gynecol. 1988;158:100-105.Crossref 67. Darj E, Stralin EB, Nilsson S. The prophylactic effect of doxycycline on postoperative infection rate after first-trimester abortion . Obstet Gynecol. 1987;70:755-758. 68. Simelaro JP, Ghen M, Ginsberg P. Evaluation of doxycycline in the treatment of acute sinusitis and bronchopulmonary disease . Curr Ther Res Clin Exp. 1980;27:769-773. 69. Jacobs P, Robinson R. Experiences with doxycycline in the management of acute respiratory tract infections . S Afr Med J. 1969;43:206-210. 70. Rogerson R. Doxycycline, a once-daily antibiotic in the treatment of chest infections in general practice . Br J ClinPract. 1971;25:175-176. 71. Maesen FPV, Davies BI, van Noord JA. Doxycycline in respiratory infections: a reassessment after 17 years . J Antimicrob Chemother. 1986; 18:531-536.Crossref 72. Anthonisen NR, Manfreda J, Warren CPW, et al. 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Copyright © 1997 American Medical Association. All Rights Reserved.
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Abstract

Abstract Although several new antibiotics have recently become available, in several clinical instances conventional antibiotics may be equally efficacious at a considerably lower cost. In today's era of cost containment, it is particularly relevant to revisit older, inexpensive antibiotics to reexplore their role in the face of the emergence of resistant microorganisms and competition from newer agents. Doxycycline is one such antibiotic. It is an inexpensive, broad-spectrum antimicrobial agent that remains the drug of first choice for several infections. In addition, it can be used for a variety of other indications. Adverse effects are infrequent and relatively minor. While interactions occur with several medications, none of these interactions has significant adverse consequences. Arch Intern Med. 1997;157:1421-1428 References 1. McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States . JAMA. 1995;273:241-242.Crossref 2. Joshi N, Milfred D. The use and misuse of new antibiotics: a perspective . Arch Intern Med. 1995; 155:569-577.Crossref 3. Duggar BM. Aureomycin: product of continuing search for new antibiotic . Ann N Y Acad Sci. 1948;51:177.Crossref 4. Finland M. Twenty-fifth anniversary of the discovery of Aureomycin: the place of the tetracyclines in antimicrobial therapy . Clin Pharmacol Ther. 1974;15:3-8. 5. Jones M, Comer JB, Cunha BA. Tetracyclines . In: Ristuccia AM, Cunha BA, eds. Antimicrobial Therapy . New York, NY: Raven Press; 1948:219-234. 6. Barza M, Brown RB, Shanks C, Gamble C, Weinstein L. Relation between lipophilicity and pharmacological behavior of minocycline, doxycycline, tetracycline, and oxytetracycline in dogs . Antimicrob Agents Chemother. 1975;8:713-720.Crossref 7. Barza M, Schiefe RT. Antimicrobial spectrum, pharmacology and therapeutic use of antibiotics, I: tetracyclines . Am J Hosp Pharm. 1977; 34:49-57. 8. Connamacher RH, Mandel HG. Binding of tetracycline to the 30 S ribosomes and to polyuridylic acid . Biochem Biophys Res Commun. 1965;20:98.Crossref 9. Maxwell IH. Studies of the binding of tetracycline to ribosomes in-vitro . Mol Pharmacol. 1968; 4:25-37. 10. Suarez G, Nathans D. Inhibition of aminoacyl-tRNA binding to ribosomes by tetracycline . Biochem Biophys Res Commun. 1965;18:743.Crossref 11. Day LE. Tetracycline inhibition of cell-free protein synthesis, II: effect of the binding of tetracycline to the components of the system . J Bacteriol. 1966;92:197-203. 12. Pato ML. Tetracycline inhibits propagation of deoxyribonucleic acid replication and alters membrane properties . Antimicrob Agents Chemother. 1977;11:318-323.Crossref 13. Kucers A, Bennett NM. The Use of Antibiotics. 4th ed. Philadelphia, Pa: JB Lippincott; 1987: 979-1044. 14. Benveniste R, Davies J. Mechanisms of antibiotic resistance in bacteria . Annu Rev Biochem. 1973;42:471-506.Crossref 15. Bread NS Jr, Armentrout SA, Weisberger AS. Inhibition of mammalian protein synthesis by antibiotics . Pharmacol Rev. 1969;21:213-245. 16. Korkelia J. Antianabolic effect of tetracyclines . Lancet. 1971;1:974-975.Crossref 17. Saivin S, Houin G. Clinical pharmacokinetics of doxycycline and minocycline . Clin Pharmacokinet. 1988;15:355-366.Crossref 18. Davis CM, Vandersarl JV, Kraus EW. Tetracycline inequivalence: the importance of 96-hour testing . Am J Med Sci. 1973;265:69-74.Crossref 19. Meyer MC, Dann RE, Whyatt PL, Slywka GW. The bioavailability of sixteen tetracycline products . J Pharmacokinet Biopharm. 1974;2:287-297.Crossref 20. Saux MC, Mosser J, Pontagnier H, Leng B. Pharmacokinetics of doxycycline pylophosphate (PPD), hydrochloride (CHD) and base (DB) . Eur J Drug Metab Pharmacokinet. 1981;6:3-10.Crossref 21. Schreiner A, Digranes A. Pharmacokinetics of lime-cycline and doxycycline in serum and suction blister fluid . Chemotherapy. 1985;31:261-265.Crossref 22. Malmborg AS. 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Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 14, 1997

References