Download The Action of Tetracycline on Acne

Article ID: WMC002714
2046-1690
The Action of Tetracycline on Acne
Corresponding Author:
Dr. Amin M Abdul Majid,
Senior Lecturer, Discipline of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia Malaysia
Submitting Author:
Ms. Laila S Azman,
Undergraduate student, School of Pharmaceutical Sciences, Universiti Sains Malaysia - Malaysia
Article ID: WMC002714
Article Type: Review articles
Submitted on:18-Dec-2011, 07:31:12 PM GMT
Published on: 19-Dec-2011, 03:40:14 PM GMT
Article URL: http://www.webmedcentral.com/article_view/2714
Subject Categories:DERMATOLOGY
Keywords:Tetracycline, Acne, Pimple, Dermatology, Antibiotic, Action
How to cite the article:Azman L S, Rahim A A, Fan S K, Abd Kadir M H, Abdul Hamid N A, Muhammad S K,
Wong A W, Abdul Majid A M. The Action of Tetracycline on Acne . WebmedCentral DERMATOLOGY
2011;2(12):WMC002714
Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
Source(s) of Funding:
None
Competing Interests:
None
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The Action of Tetracycline on Acne
Author(s): Azman L S, Rahim A A, Fan S K, Abd Kadir M H, Abdul Hamid N A, Muhammad S K, Wong A W,
Abdul Majid A M
Abstract
There are few types of acne ranging from mild to
severe such as Acne Vulgaris, Acne Rosacea,
Pyoderma Faciale, Gram-negative Folliculitis, Acne
Conglobata and the most severe one is Acne
Fulminans. Tetracycline can be used to treat acne
problems and is administered orally and topically.
Generally, tetracycline is bacteriostatic but can be
bactericidal if given in higher dose. It is widely
distributed throughout tissues and excreted
unchanged via renal and biliary routes. The most
common side effects are nausea, headache and
staining of the teeth. Besides tetracycline, doxycycline
and minocycline are also used for treatment of acne at
a lower dose. Tetracycline should not be given to
patients having hypersensitivity to tetracycline,
pregnant women and lactating mothers. It should not
be taken together with milk, antacids and oral
contraceptive.
Introduction
What is acne?
Acne is a common disorder affecting people of all
races and ages. It is a skin condition that causes
comedones (blackheads and whiteheads) and
inflamed red growths (papules, pustules, and cysts),
formation of nodules (large papules) and possibly
scarring. It is also known as acne vulgaris or cystic
acne (1, 2). Commonly, they are called pimples which
usually appear on the face but they can also develop
on the other parts of the body such as the back, the
shoulders, neck and chest (3).
Pustule is a red circle with a white or yellow centre. A
small, red, tender bump with no head is called papule.
Whereas cyst is a closed sac filled with fluid, pus, or
other material. Whitehead is formed when the oil
breaks though to the surface. The oil changed from
white to black after being oxidized and result in
blackhead (4).
There are a few types of acne. The most common type
of acne is Acne Vulgaris, literally means “common
acne”. It is categorized as mild or moderate type. This
type of acne is characterized by its different forms of
lesions which include blackheads, whiteheads,
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papules, pustules, nodules and cysts (5). It can be
treated with some simple home remedies.
Acne Rosacea usually affects people over the age of
30. It frequently occurs in women but often more
severe when found in men. It looks similar to Acne
Vulgaris which leads to confusion however they have
distinct ways of treatment. It is manifested in the form
of a red rash on the forehead, cheeks, nose and chin
(6). The redness is often accompanied by bumps,
pimples, and skin blemishes (5).
Pyoderma Faciale is the other type of acne. It is also
known as Rosacea Fulminans. It is severe facial acne
affecting only females, usually between the ages of 20
to 40 years old which comes with nodules, pustules as
well as sores and may leave permanent scarring. It
occurs most often in women who have never
experienced acne before and fortunately it does not
last longer than a year (5).
The fourth type of acne called Gram-negative
folliculitis. It is a rare condition of bacterial infection
that comes with long-term treatment of acne with
antibiotics. It will result in pustules and cysts (7).
Acne Conglobata is the most severe type of acne and
mainly affects males. It is characterized by numerous
large interconnected lesions on the face, chest, back,
buttocks, upper arms, and thighs and can be
accompanied by numerous widespread blackheads. It
leads to severe psychological as well as physical
suffering since it is extremely disfiguring. To make
thing worse, it causes damage to the skin and
permanent scarring (7).
The last type of acne is known as Acne Fulminans. It
is an abrupt onset of acne conglobata-like symptoms
accompanied with fever and aching of the joints. It
normally occurs in young men. Isotretinoin and oral
steroids are normally prescribed to get rid of it (5, 6).
Causes of acne
The main culprit of acne is the excess production of an
oily substance called sebum resulting in blockage of
hair follicles. The exact cause of acne is not fully
understood. However, the elements that influence its
development are known. It can be due to heredity, oily
skin or hair, hormonal imbalance, some prescription
medications and cosmetics that contain chemicals and
vegetable oil, high stress, and possibly some
nutritional deficiencies (8).
Heredity or genetics is one of the factors that cause
acne. Researchers believe that inheritance from
parents increase the tendency of their children to
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develop acne (6). People with over-sensitive oil glands
cause them keep on producing a higher level of
sebum. Hence, their oily complexions cause them
more prone to having acne (9).
Fluctuation or imbalances of hormonal levels are often
regarded as the main cause of acne. It can be seen
when most people start to have acne when they reach
puberty which referred to teenage growth phase.
During this stage, teenagers start to produce
androgens. It enlarges sebaceous glands and greater
amounts of sebum are produced which mix with the
dead skin cells or bacteria on the skin’s surface,
resulting in the pores becoming blocked. Hence,
inflammation starts to occur. Acne also appears when
women undergo menstruation whereby their hormone
levels are imbalanced (9, 10).
In fact, dietary intake is closely related to hormonal
levels. People who are more prone to acne breakouts
will have higher risks to get acne when they eat more
unhealthy food. This is because food with higher
content of chemicals and fat contributes to hormonal
imbalance which will induce ailments such as acne
(10).
Besides, stress is also a factor that aggravates acne.
When a person is under stress, more adrenaline
hormones are produced and excessive hormones are
responsible for repeated acne breakouts by reducing
the nutrient-absorbing capacity of the body and
immediately attacking the skin. Stress actually slows
down the healing process of both severe open wounds
and small acne pustules since it affects the immune
system of the body. In other words, adults are more
prone to stress-related acne as they at higher risk of
getting stress (11).
Deficiency of certain nutrient in body especially vitamin
may lead to acne aggravation. Acne development is
closed related to Vitamins A, B, C, E and zinc.
Vitamins act as antioxidants that assist skin in
elimination of toxins and harmful free radicals. Lack of
vitamins will increase the exposure of skin to toxins
and bacteria that may contribute to development of
acne(10).
How acne can occur?
There are many tiny holes on our skin surface called
pores. Each pore will grow a hair which known as hair
follicle. The hair follicles in our skin are connected with
oil glands called sebaceous glands. The sebaceous
glands produce sebum that helps to lubricate the skin
by keeping the skin surface oily and protecting the skin.
On the other hand, dead skin cells shed away from the
pore lining whereas sebum is being distributed to the
exterior surface of the skin (8, 12).
In normal skin, the pore is open and the right amount
of sebum secreted will come out on the skin surface.
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However, when too much of oil/sebum is produced,
the pores get clogged up. The blockage of pore also
called plug. The plug traps the dead skin cells, dirt and
debris within the hair follicles. This will prevent the
sebum from leaving the pores which results in bacteria
as well as inflammatory cells building up underneath
the skin. Subsequently, the skin swells and red bumps
are formed. These indicate the formation of acne. If
the inflammation is deep in the skin, the pimples will
enlarge to form cysts (1). The acne lesions we know
as whiteheads and blackheads are called
“comedones”. Red, swollen, pus-filled lesions are
called papules, nodules, and pustules (13). We can
also conclude that areas where a lot of sebaceous
glands are present tend to have higher chance to
develop acne as the blockage of pores may occur
frequently.
Common Uses Of Tetracycline
Other than acne, tetracycline is widely used against
other bacterial infection because of its wide spectrum
activity such as infection caused by ticks, Lyme
disease and Rocky Mountain spotted fever(RMSF)
(14). Lyme disease is the most common tick-borne
disease caused by bacteria which belong to the genus
of Borrelia. The RMSF caused by bacteria Rickettsia
rickettsii is a lethal condition and tetracycline must be
given instantly. Doxycyline is usually used in treatment
of Lyme disease and RMSF (15).
Tetracycline is also used in the treatment of urinary
tract infection (UTI). Urinary tract infection is one of the
most commonly found infection in developed countries,
and it is eight or nine times more frequent among
women than men especially elderly women (16).
Besides, sexual intercourse is also one of the risk
factor. The types of bacteria include E. coli, Klebsiella,
Proteus, Pseudomonas, Serratia, and enterococcus
but rarely include anaerobes.
In addition, tetracycline is widely used in the treatment
of Helicobacter pylori infections. It is a gram-negative
bacterium found in human stomach which causes
gastritis and gastric ulcers. In serious condition, it can
lead to duodenal ulcers and stomach cancer.
Tetracycline is usually combined with antacids,
H2-antagonists or proton pump inhibitors to kill the
Helicobacter pylori.
Moreover, tetracycline is the preferred choice of
treatment for patients who develop resistance to the
penicillin such as Anthrax, Gonorrhea and Syphilis (17)
Some of the common uses of tetracycline are shown
in Table 1.
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Mechanism of Action of
Tetracycline
Tetracycline is generally bacteriostatic against most
organisms, but high concentrations of tetracycline can
be bactericidal. The structure of tetracycline can be
seen in the Figure 1. The antimicrobial action of
tetracycline in acne occurs via protein synthesis
inhibition. It acts by binding to the 30S subunit of the
microbial ribosome. Tetracycline gains access to the
ribosome after passive diffusion through porin
channels in the bacterial membrane. An active
transport process also exists in bacterial cells. During
protein biosynthesis, the new t-RNA with the amino
acid will try to bind to A-site of the ribosome. However,
since the A-site is blocked by the tetracycline, the
aminoacyl-tRNA cannot bind to it. Thus without the
sequential attachment of the tRNA at the A-site,
protein biosynthesis cannot occur. By inhibiting the
protein biosynthesis process, tetracycline will cause
cell death of the bacterial cell. This action is usually
inhibitory and reversible upon withdrawal of the drug.
Mammalian cells are not affected by tetracycline
because they do not contain 30S ribosomal subunit
(18).
Tetracycline, by targeting problematic surface bacteria,
inhibits production of bacterial products that stimulate
inflammation. Tetracycline will cause down-regulation
of proinflammatory cytokines (ie,TNF-a, IL-1b, IL-6),
production of anti-inflammatory cytokine (ie, IL-10)
secretion and reduction in antibody production (19)
Mechanism of Resistance of
Tetracycline
Tetracycline is a bacteriostatic agent which has a wide
spectrum of uses itherapeutically. In general, it acts on
bacteria by stopping the protein synthesis to inhibit the
growth of the bacteria. The use of this antibiotic is very
famous since it has broad spectrum activity and low
toxicity. However, the bacteria could evolve and
become resistant to the antibiotic (20). The emergence
of tetracycline-resistant bacteria has resulted in the
decrease and limit of the therapeutic action of
tetracycline. Indeed, tetracycline resistance in many
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commensal and pathogenic bacteria has emerged
now due to genetic achievement of tetracycline
resistance genes (21). Recently, three difference
specific mechanisms of tetracycline resistance are
found - tetracycline efflux, ribosome protection and
tetracycline modification (22).
Emergence of the tetracycline resistance is primarily
due to possession of genetically mobile tetracycline
resistance genes, which encode proteins that confer
ef?ux of tetracyclines, or ribosomal protection (21).
These first two mechanisms are the most common
and most of their genes are usually attained via
transferable plasmids and/or transposons. The
presence of both mechanisms in aerobic and
anaerobic Gram-negative or Gram-positive bacteria
indicates their wide distribution among the bacterial
kingdom (21).
In tetracycline efflux, its genes code for
membrane-associated proteins, which export
tetracyclines from the cell major facilitator superfamily
(MFS) (23). Tetracycline efflux mechanism is an
approach to limit the access of tetracycline to
ribosome which can inhibit protein synthesis of the
bacteria (22). The result from the export of tetracycline
will reduce the intracellular drug concentration and
thus, protects the ribosomes within the cell (23). The
resistance gene product is a cytoplasmic membrane
protein that is an energy-dependent tetracycline
transporter (22).
The other type of tetracycline resistance mechanism is
ribosomal protection protein. This is the least familiar
mechanism, however it is probably more widespread
than tetracycline efflux (24). The protein called
cytoplasmic protein interacts or associates with the
ribosome, making it insensitive to tetracycline
inhibition (21, 22). Ribosome protection is mediated by
a soluble protein which shares homology with the
GTPases participating in protein synthesis, namely
EF-Tu and EF-G (25, 26). At the N-terminal area, the
greatest homology is seen which contain the
GTP-binding domain (25). Thus, the RPPs bind and
hydrolyze GTP in a ribosome-dependent manner, and
maintenance of this activity is important for in vivo
activity (27). The mechanism of ribosomal protection
works in vivo and in vitro, unlike the action of ef?ux
proteins; which require intact membranes to function
(21). On the other hand, the RPPs may be
evolutionarily derived from the elongation factors, such
that they lost their original function and have been
adapted to function in tetracycline resistance (27).
The third mechanism of tetracycline resistance is
tetracycline modification. This reaction only works in
aerobic environment, in the presence of both oxygen
and NADPH and does not function in the natural host
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(Bacteroides) (21, 22). There is only one type of gene
encodes the tetracycline resistance due to enzymatic
alteration of tetracycline that is the tet(X) gene. Its
product is a 44-kDa cytoplasmic protein that
chemically modifies tetracycline (21). The tet(X) gene
is classified according to the resistance gene which
shares amino acid homology with a number of
NADPH-requiring oxidoreductases, particularly in the
region containing the NADPH-binding site (22, 28).
However, the clinical significance of tet(X) is still
unclear nor confer resistance on the Bacteroides
strains in which it was originally found, but it requires
such high levels of ventilation so it probably could not
confer meaningful levels of resistance in the
microaerophilic environment found in most sites on the
human body (22).
Pharmacokinetics Profile of
Tetracycline
Administration: Tetracycline can be given orally,
periodontally, ophthalmic (eyes) or topically (29).
However, in order to treat acne vulgaris, oral
tetracycline is usually prescribed (30).
Absorption: Oral tetracycline has relatively high
absorption in GIT which is 77-88% (30). It has high
solubility but quite poor permeability (30). Absorption
of tetracycline is reduced by administration with food,
iron and milk (31). This is because iron, calcium,
magnesium and aluminium will chelate tetracycline in
GIT, hence reducing its absorption(30).
Distribution: Tetracycline is widely distributed
throughout the tissues (30). However, since it is not
highly lipophilic, it may not optimally penetrate the
follicular unit (30). This is due to the fact that follicular
unit contains high amounts of lipid-rich sebum (30).
Metabolism: Tetracycline does not undergo any
metabolism(32).
Excretion: Tetracycline is excreted unchanged via
renal and biliary routes (32). About 50% of the drug is
excreted through glomerular filtration (32).
Side Effects of Tetracycline
Every medication has its own side effect. The same
goes to tetracycline. If the side effect is severe, then
stop using the medication.
The common mild side effects of using tetracycline are
stinging, redness, burning, peeling, and itchiness. Any
allergic reaction towards tetracycline can be
considered as severe side effects and its usage
should be stopped.
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The other possible mild side effects of taking
tetracycline include nausea, headache, stomach
cramp, and vomiting (33). Indigestion, abdominal
upset, gastrointestinal irritation (severe), rashes (rare,
severe if they manifest), phototoxic reactions
(oversensitivity to sunlight), the increased incidence of
candidal valvovaginitis, severe headaches, hives,
drug-induced hepatitis are also some of the side
effects of using tetracycline. Skin, nails and eyes may
become yellow or known as jaundice (34).
The side effects are not similar to all the patients. It is
dependent on the condition of a patient and how his
body tolerates tetracycline.
Results of a study done in 2004 indicated that
tetracycline as well as other tetracycline derivatives
may well be responsible for staining of the teeth as
well as the oral cavity. Besides staining of the oral
cavity and teeth, further research indicated that acne
treatments containing cyclones may also cause
adverse drug reactions (36). Tetracycline should not
be used in children because it can cause permanent
discoloration of the natural hue of the teeth
(yellowing). The same goes to the pregnant women.
They cannot use tetracycline during pregnancy
because the fetus may experience slower bone growth.
Their teeth may also be affected once they are born
(34).
Tetracycline may also increase the risk of autoimmune
disorders, hypersensitivity syndromes and abnormal
skin pigmentations. A reported released by a
university in Germany indicates that side effects
related to the use of tetracycline may include
contraction of Sweet's syndrome. Sweet’s syndrome is
a condition in which painful red nodules arise on
various parts of the body and is also generally
accompanied by fever and malaise (38).
A study published by a hospital in France in May of
2003 indicates that ‘adverse affects of cyclines might
be serious and sometimes unknown.’ The report
further suggested that ‘long term treatment by
tetracycline must be researched in patients presenting
such symptoms.’ Symptoms related to adverse side
effects in nearly 250 cases included autoimmune
disorders, hypersensitivity syndromes as well as
abnormal skin pigmentations (37).
A report released in February of 2000 indicated that
tetracycline could also be responsible for the induction
of intracranial hypertension (39).
Research indicates that patients who are considering
the use of tetracycline to consider the risks associated
with this acne treatment before proceeding with
use(35).
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Formulations of Tetracycline
The oral dose of tetracycline for treating acne is from
125mg to 500mg depending to the severity of the acne.
Beside tetracycline, doxycycline and minocycline are
also used for treatment of acne at a lower dose (40).
Table 2.1 shows a list of tetracycline, minocycline and
doxycycline product available in Malaysia. While Table
2.2 shows the international listing of tetracycline,
minocycline and doxycycline brand name.
Most oral tetracycline is formulated into capsule or
tablet form which gives tetracycline a better stability to
the tetracycline when taken orally. This is because
tetracycline degrades to epitetracycline due to
epimerization in protic solvent which cause the
tetracycline to be inactive (40). Besides that, the
release of tetracycline is controlled when it is given in
tablet or capsule form over its solution form (40).
Beside oral route, tetracycline is also formulated for
topical route. The dosage forms used are cream,
ointment and gel (40). The topical form of tetracycline
is mostly applied to a small area affected by acne
because usage over a larger area has been proven to
be awkward (40). Besides that, topical application of
tetracycline could avoid the gastrointestinal
disturbance caused by the drug and drug interactions
which may occur if taken orally. The first stable topical
tetracycline produced was in ointment form because
tetracycline is relatively stable in the ointment base
(40). However for cosmetic use, the oily formulation is
less desirable thus the formulation of a less greasy
cream was created. Finally the gel formulation of
tetracycline was created which is stable, non-greasy,
less irritating and soft for the skin (40).
Drugs Interactions And
Contraindications
Tetracycline is contraindicated in patients known to
have tetracycline hypersensitivity (47).
Tetracycline is bacteriostatic. So, tetracycline must not
be given in conjunction with penicillin or other
bactericidal antibiotics because it may disturb the
bactericidal action of penicillin (49). Bacteriostatic and
bactericidal antibiotics should not be used together
since the bactericidal agents, for example, penicillins
may be inhibited by the bacteriostatic agent too (48).
Treatment with tetracycline can alter the normal flora
of the colon and allow overgrowth of Clostridium
difficile. Hence, the patient may suffer from diarrhea
during treatment. Symptomatic of Clostridium
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difficile-associated disease, pseudomembranous
colitis, may also occur in the initial weeks of the
following treatment. If patient is suspected to have
pseudomembranous colitis, tetracycline should be
stopped immediately and the patient should be treated
with supportive and specific treatment without delay.
Any products that inhibit peristalsis are contraindicated
in this clinical situation (47).
There are some compounds that may interfere with
the bioavailability of tetracycline antibiotics. These
include antacids; sucralfate; magnesium salicylate;
magnesium citrate; polysaccharide-iron complex;
quinapril (tablets contain magnesium); and
multivitamins that contain iron, calcium, manganese,
or zinc. Laxative preparations containing magnesium
are also contraindicated. So, tetracycline should not
be given with or within 4 hours of any of the above
drugs. Besides, calcium salts and magnesium salts
that are contained in food and dairy products can form
chelates with tetracycline and decrease the absorption.
Administration of tetracycline at least one hour prior to
or two hours after a meal and/or milk will reduce the
effect (47).
Warfarin has shown a clinically significant interaction
with tetracycline because the action of warfarin and
other oral anticoagulants are increased by either
impairing prothrombin utilization or decreasing
production of vitamin K (48).
Tetracycline should not be used with acitretin,
isotretinoin, strontium, and tretinoin that are taken
orally because very serious interactions may occur.
Zinc can affect tetracycline because it can attach to
tetracycline in the stomach. This reduces the amount
of tetracycline absorbed. Thus, it will decrease the
effectiveness of tetracycline too (49).
Tetracycline may chelate the divalent or trivalent
cations, forming insoluble compounds (50).
Tetracycline bioavailability may be decreased by
didanosine, due to the buffering agents in didanosine
tablets or powder. Some antidiarrheals that comprise
of cations will form chelated compounds too (50).
Concurrent use of tetracycline with oral contraceptives
may make the oral contraceptives less effective (50).
This is due to stimulation of estrogen metabolism or a
decline in estrogen enterohepatic circulation via
changes in gastrointestinal flora (48).
Topical tetracycline preparations contain sodium
sulfites while oral dosage forms may contain tartrazine
dye. More precaution steps should be considered
when dealing with patients with a known sulfite
hypersensitivity or tartrazine dye hypersensitivity.
Sensitivity reactions are prone to have happen in
asthmatic than in non-asthmatic patients (50).
If a pregnant mother wants to use the tetracycline, she
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should know that all tetracyclines have a harmful effect
on the skeletal development and bone growth of the
fetus or child. Therefore, tetracycline should not be
used in the second half of pregnancy unless there are
more benefits from treatment to the mother compared
to the risk of fetus, but their use should be considered
only with extreme caution (47).
Although tetracycline can form non absorbable
complexes with the calcium in breast milk, tetracycline
is distributed into breast milk. Therefore,
breast-feeding mothers should not use tetracycline
antibiotics because risks o) teeth discoloration, enamel
hypoplasia, inhibition of linear skeletal growth, oral and
vaginal thrush, or photosensitivity reactions can
happen in the nursing infant (47).
Dosage and frequency of tetracycline must be
adjusted if given to patients with severe renal disease
because some of the tetracycline is excreted in
unchanged in the urine (47).Dose adjustment may be
required in patients with hepatic disease too because
some tetracycline is excreted via bile. The excretion
process can be delayed in these patients (47).It has
been reported that fatal renal toxicity can occur with
the concurrent use of tetracycline and methoxyflurane
(50).
Conclusion
Tetracycline is one of the antibiotics that can treat
acne and it can be given orally or topically. All the do’s
and don’ts of tetracycline must be followed to ensure
the effectiveness of the antibiotic. The number of
bacteria in and around the follicle can be decreased by
using the antibiotic. Antibiotic can also decrease the
irritating chemicals produced by white blood cells and
reduce the concentration of free fatty acids in the
sebum, thus reducing the inflammatory response (51).
Finally this results in fewer pimples and less redness.
If left untreated, acne can lead to a number of
problems such as pain, infections, and scarring (52).
Acknowledgement
We would like to acknowledge and extend our heartfelt
gratitude and appreciation to the following persons
who have made the completion of this report possible
to be done successfully. Special thanks to Dr. Amin
Malik Shah bin Abdul Majid, Discipline of
Pharmacology, School of Pharmaceutical Sciences,
Universiti Sains Malaysia for his vital encouragement
and support throughout the period of time as our
supervisor.Not only that, we thankful for the constant
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reminders and much motivation from him.
Besides, we also want to thank all of FAR 241
Antimicrobial Therapy lecturers; which they taught us
the concept of antimicrobial therapy in pharmacy field
and special thanks to Lydia Pang Kai Tsan for helping
us checked the grammatical errors in our report.
We would also like to forward our thanks to those
contributed accidentally or in-accidentally throughout
this report. On top of that, we would like to express our
appreciation to all group members that fully
contributed and committed in making this report
succeed.
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36. Int J Dermatol. 2004 Oct;43(10):709-15. PubMed
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aAAAAEBAJ&dq=tetracycline+topical+formulation
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Illustrations
Illustration 1
Table 1: Some of the common uses of tetracycline
Tetracycline in bacterial infection

Lyme disease

Rocky Mountain spotted fever

Typhus fever

Tick fever

Conjunctivitis (pink eye)

Chlamydia

Certain types of pneumonia and other respiratory infections

Urinary tract infections (UTIs)

Plague

Cholera

Skin infections
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Gram Positive
Gram Negative

Streptococcus pyogenes

Neisseria gonorrhea

Streptococcus pneumoniae

Haemophilus influenzae

Enterococcus group

Vibrio cholera

Brucella

Escherichia coli

Klebsiella

Enterobacter

Shigella
Other Microorganisms

Borrelia

Treponema pallidum

Fusobacterium

Actinomyces species
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Illustration 2
Figure 1
FIGURE 1: The 4 rings of the basic tetracycline structure.
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Illustration 3
TABLE 2.1: List of tetracycline, minocycline and doxycycline product available in Malaysia
Product name
MYCIN CAPSULE 2470 MG
VEMYCLIN
CAPSULE
2470MG
BETACYCLINE
TABLET
2470
PHARMYCIN
Company name
KCK
PHARMACEUTICAL
2470MG
Dosage
ingredient
form
Tetracycline
INDUSTRIES SDN. BHD.
HCL
IDAMAN
Tetracycline
PHARMA
MANUFACTURING
HCL
UPHA
Tetracycline
PHARMACEUTICAL
MFG. (M) SDN BHD
CAPSULE
Active
M
A
L
A
Y
Reference
Capsule
44
Capsule
44
Tablets
44
Capsule
44
HCL
A
N
PHARMACEUTICAL
Tetracycline
HCL
INDUSTRIES SDN BHD
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TETRACYCLINE
MC
KOMEDIC SDN BHD
Tetracycline
CAPSULE 2470MG
Capsule
44
Capsule
44
Ointment
44
Capsule
44
Tablets
44
HCL
TETRA CAPSULE 2470MG
ROYCE
PHARMA
Tetracycline
MANUFACTURING SDN BHD
HCL
T E T R A C Y C L I N E
HOE
Tetracycline
OINTMENT 3% W/W
SDN. BHD.
TRIOMYCIN
Z
CAPSULE
2470MG
O
PHARMACEUTICAL
N
HCL
T
R
PHARMACEUTICALS
O
N
SDN.
Tetracycline
HCL
BHD.
DHATRACIN
TABLET
2470MG
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ASCENT
PHARMAHEALTH
MALAYSIA SDN. BHD.
Tetracycline
HCL
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TETRACYCLINE
KOTRA PHARMA (M) SDN
Tetracycline
CAPSULES
BHD
HCL
TETRACYCLINE CAPSULE
DYNAPHARM (M) SDN SHD
Tetracycline
2470MG
Capsule
44
Capsule
44
Tablets
44
Capsule
44
Capsule
44
HCL
TETRACYCLINE TABLET
DYNAPHARM (M) SDN SHD
2470MG
Tetracycline
HCL
TETRACAP 2470 CAPSULE
HOVID BERHAD
Tetracycline
HCL
TETRACAP
CAPSULE
4700MG
WebmedCentral > Review articles
HOVID BERHAD
Tetracycline
HCL
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P H A R M A N I A G A
P H A R M A N I A G A
Tetracycline
Capsule
44
TETRACYCLINE CAPSULE
MANUFACTURING BERHAD
HCL
Y.S.P. INDUSTRIES (M) SDN
Minocycline
Capsule
45
Minocycline
Capsule
45
Minocycline
Capsule
45
Doxycycline
Capsule
46
2470MG
BORYMYCIN
CAPSULE
470MG
BHD
BORYMYCIN CAPSULE
Y.S.P. INDUSTRIES (M) SDN
BHD
APO-MINOCYCLINE
P H A R M A F O R T E
470MG
(MALAYSIA) SDN. BHD.
XIDOX CAPSULE 100MG
IDAMAN
PHARMA
MANUFACTURING SDN BHD
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ASIDOXYN CAPSULE 100
ROYCE
PHARMA
Doxycycline
Capsule
46
MG
MANUFACTURING
KOMEDIC SDN BHD
Doxycycline
Capsule
46
PFIZER (MALAYSIA) SDN.
Doxycycline
Tablets
46
Doxycycline
Tablets
46
SDN.
BHD
MEDOMYCIN
CAPSULE
100MG
VIBRAMYCIN
TABLET
100MG
DOXYCILLIN
BHD.
TABLET
100MG
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UPHA
PHARMACEUTICAL
MFG. (M) SDN BHD
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CAPSULE
P H A R M A N I A G A
Doxycycline
Capsule
46
100MG
MANUFACTURING BERHAD
DOXYCAP 100MG
HOVID BERHAD
Doxycycline
Capsule
46
DOXYMYCIN CAPSULE
Y.S.P. INDUSTRIES (M) SDN
Doxycycline
Capsule
46
BHD
DOXYCYCLINE
TABLET
DYNAPHARM (M) SDN BHD
Doxycycline
Tablets
46
DOXYCYCLINE CAPSULE
DYNAPHARM (M) SDN BHD
Doxycycline
Capsule
46
100MG
100MG
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DOLINE 100 TABLET
MERCK SDN. BHD.
Doxycycline
Tablets
46
VIBRAMYCIN
PFIZER (MALAYSIA) SDN.
Doxycycline
Tablets
46
Doxycycline
Capsule
46
Doxycycline
Capsule
46
TABLET
100MG
BHD.
P H A R M A N I A G A
P H A R M A N I A G A
DOXYCYCLINE CAPSULE
MANUFACTURING BERHAD
100 MG
DOXYMYCIN CAPSULE
Y.S.P. INDUSTRIES (M) SDN
BHD
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DOXYCILLIN
CAPSULE
100 MG
DOMYCIN
CCM
PHARMACEUTICALS
Doxycycline
Capsule
46
DUOPHARMA (M) SDN. BHD.
Doxycycline
Tablets
46
RANBAXY
Doxycycline
Capsule
46
SDN. BHD.
TABLET
100
MG
TETRADOX
CAPSULES
100 MG
WebmedCentral > Review articles
(MALAYSIA)
SDN. BHD.
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Illustration 4
TABLE 2.2: International listing of tetracycline, minocycline and doxycycline brand name
Name
Active ingredient
Reference
Abramycin
Tetracycline
43
Abricycline
Tetracycline
43
Achromycin
Tetracycline
43
Achromycin V
Tetracycline
43
Actisite
Tetracycline
43
Agromicina
Tetracycline
43
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Ambramicina
Tetracycline
43
Ambramycin
Tetracycline
43
Amycin
Tetracycline
43
Bio-Tetra
Tetracycline
43
Biocycline
Tetracycline
43
Bristaciclin
Tetracycline
43
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Bristaciclina
Tetracycline
43
Bristacycline
Tetracycline
43
Cefracycline
Tetracycline
43
Ciclibion
Tetracycline
43
Copharlan
Tetracycline
43
Criseociclina
Tetracycline
43
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Cyclopar
Tetracycline
43
Cytome
Tetracycline
43
Democracin
Tetracycline
43
Deschlorobiomycin
Tetracycline
43
Dumocyclin
Tetracycline
43
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Enterocycline
Tetracycline
43
Hostacyclin
Tetracycline
43
Lexacycline
Tetracycline
43
Limecycline
Tetracycline
43
Liquamycin
Tetracycline
43
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Medocycline
Tetracycline
43
Mericycline
Tetracycline
43
Micycline
Tetracycline
43
Neocycline
Tetracycline
43
Oletetrin
Tetracycline
43
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Omegamycin
Tetracycline
43
Orlycycline
Tetracycline
43
Panmycin
Tetracycline
43
Polycycline
Tetracycline
43
Polyotic
Tetracycline
43
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Purocyclina
Tetracycline
43
Resteclin
Tetracycline
43
Retet
Tetracycline
43
Robitet
Tetracycline
43
Roviciclina
Tetracycline
43
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SK-Tetracycline
Tetracycline
43
Solvocin
Tetracycline
43
Sumycin
Tetracycline
43
TAC
Tetracycline
43
Tetra-CO
Tetracycline
43
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Tetrabon
Tetracycline
43
Tetrachel
Tetracycline
43
Tetracycl
Tetracycline
43
Tetracycline II
Tetracycline
43
Tetracyn
Tetracycline
43
Tetradecin
Tetracycline
43
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Tetrafil
Tetracycline
43
Tetramed
Tetracycline
43
Tetraverine
Tetracycline
43
Tetrex
Tetracycline
43
Topicycline
Tetracycline
43
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Tsiklomistsin
Tetracycline
43
Tsiklomitsin
Tetracycline
43
Veracin
Tetracycline
43
Vetacyclinum
Tetracycline
43
Alti-Minocycline
Minocycline
42
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Apo-Minocycline
Minocycline
42
Arestin
Minocycline
42
Dynacin
Minocycline
42
Gen-Minocycline
Minocycline
42
Klinomycin
Minocycline
42
Minociclina
Minocycline
42
Minocin
Minocycline
42
Minocyclin
Minocycline
42
Minocycline HCl
Minocycline
42
Minocyclinum
Minocycline
42
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Minocyn
Minocycline
42
Minomycin
Minocycline
42
Novo-Minocycline
Minocycline
42
Solodyn
Minocycline
42
Vectrin
Minocycline
42
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Alti-Doxycycline
Doxycycline
41
Apo-Doxy
Doxycycline
41
Atridox
Doxycycline
41
Doryx
Doxycycline
41
Doxy 100
Doxycycline
41
Doxy-Caps
Doxycycline
41
Doxy-Lemmon
Doxycycline
41
Doxychel
Doxycycline
41
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DoxychelHyclate
Doxycycline
41
Doxycin
Doxycycline
41
Doxylin
Doxycycline
41
Doxytec
Doxycycline
41
Jenacyclin
Doxycycline
41
Monodox
Doxycycline
41
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Novo-Doxylin
Doxycycline
41
Nu-Doxycycline
Doxycycline
41
Oracea
Doxycycline
41
Periostat
Doxycycline
41
Supracyclin
Doxycycline
41
Vibra-Tabs
Doxycycline
41
Vibramycin
Doxycycline
41
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