(2) When penicillin is contraindicated, tetracyclines are alternative drugs in
treatment of gonorrhea, syphilis, yaws, actinomycosis, and infections caused by gram-
positive bacilli (anthrax, gas gangrene, and tetanus).
(3) Oral forms of tetracycline may be a useful adjunct to the chronic
management of severe acne.
(4) Other infections caused by gram-negative and gram-positive organisms
when bacteriologic testing indicates appropriate susceptibility. However, other
antibiotics are usually considered agents of first choice.
5-24. USUAL DOSAGE
The doses for tetracycline hydrochloride and oxytetracycline are given below:
a. Intramuscular. Intramuscular administration is not recommended since IM
injections are painful and tetracycline is poorly absorbed from the muscles. The usual
daily dose of tetracycline or oxytetracycline is 250 mg IM once every 24 hours or 300
mg given in divided doses at 8- to 12-hour intervals.
b. Intravenous. Intravenous administration should be considered only if rapid,
high blood levels are needed especially in an acutely ill client. Oral therapy should be
instituted as soon as possible, as IV therapy given over prolonged periods of time may
result in thrombophlebitis. The usual adult dose of tetracycline or oxytetracycline is 250
to 500 mg IV every 12 hours, not to exceed 500 mg every 6 hours or 2 grams per day.
c. Oral. Oral forms of tetracyclines should be given one hour before or two
hours after meals. The usual adult daily dose of tetracycline is 1 to 2 grams orally per
day, divided in 2 to 4 equal doses depending on the severity of the infection. In the
treatment of acne, an initial dose of 0.5 to 1.0 gram daily is used for a few weeks, then
decreased to 250 mg per day for maintenance.
NOTE: The absorption of oral tetracyclines is impaired when they are taken with
antacids containing aluminum, calcium, or magnesium. Food and some dairy
products (milk) also interfere with absorption. Recent evidence also suggests
that iron compounds interfere with absorption.
5-25. ADVERSE REACTIONS
a. Gastrointestinal--anorexia, nausea, vomiting, diarrhea, glossitis, and lesions
with Candida overgrowth in the anogenital region. These are the most common
reasons for discontinuing tetracycline therapy.
b. Dermatological--rashes, photosensitivity, especially with demeclocycline.