demeclocycline
Sources réglementaires consultées
Indications approuvées
- Infections dues à des bactéries sensibles, notamment rickettsioses, infections à Mycoplasma et Chlamydia et autres indications de la notice, guidées par culture et sensibilité.
Contre-indications
Absolues
- Hypersensibilité aux tétracyclines ou aux composants.
Mises en garde cliniques
- Mise en garde majeure · Ne pas utiliser pendant le développement dentaire jusqu’à 8 ans sauf bénéfice indispensable ; il peut provoquer une coloration dentaire permanente et une hypoplasie de l’émail. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- Mise en garde majeure · Il peut provoquer un diabète insipide néphrogénique et une accumulation/toxicité en cas d’insuffisance rénale. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- Mise en garde majeure · Il peut provoquer une diarrhée à Clostridioides difficile, y compris après la fin du traitement ; arrêter et traiter selon la gravité. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- Il peut provoquer une photosensibilité. Limiter l’exposition solaire/UV et arrêter en cas d’érythème important. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
Interactions médicamenteuses
- ModéréeAntiacides, fer, calcium, magnésium, zinc et produits laitiers
Mécanisme: La chélation réduit l’absorption orale.
Recommandation: Espacer les prises selon le RCP et administrer avec beaucoup d’eau.
DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- ModéréeAnticoagulants
Mécanisme: Il peut réduire l’activité de la prothrombine.
Recommandation: Surveiller l’INR et réduire l’anticoagulant si nécessaire.
DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
Effets indésirables
Communs (≥1%)
Nausées, vomissements, diarrhée et gêne épigastrique
Rares mais graves
Hépatite, insuffisance hépatique, œsophagite ulcéreuse et hypertension intracrânienne
Grossesse et allaitement
Éviter pendant la grossesse, surtout à partir de la seconde moitié, en raison d’un risque d’atteinte dentaire permanente et de retard de croissance osseuse fœtale. Envisager d’interrompre l’allaitement ou le traitement.
Bibliographie récente (PubMed)
Hyponatremia is the most common electrolyte disorder encountered in clinical practice. Conventional management strategies, including fluid restriction, hypertonic saline, and solute supplementation, often fail to achieve sustained correction, particularly in the syndrome of inappropriate antidiuretic hormone secretion (SIADH), resulting in refractory cases. A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eligible studies included randomized controlled trials, cohort studies, guideline syntheses, and mechanistic research, with risk of bias carefully evaluated. Seven studies met inclusion criteria. Tolvaptan consistently improved serum sodium concentrations in patients with SIADH and heart failure, though its use was limited by high cost and the potential for overly rapid correction. Oral urea emerged as a safe, inexpensive, and reliable option for gradual, sustained normalization of sodium levels. Vasopressin receptor antagonists (vaptans) demonstrated superiority over fluid restriction in oncology-associated hyponatremia, although relapse was frequently observed following discontinuation. Demeclocycline exhibited mechanistic efficacy but remains limited by nephrotoxicity risk. Guideline-based analyses emphasized improved diagnostic precision but revealed inconsistencies in correction thresholds and recommendations for second-line therapy. When standard correction measures fail, clinicians should reassess the underlying etiology and escalate treatment accordingly. Vaptans offer rapid correction, urea ensures safe long-term management, and demeclocycline serves as a last-line therapeutic option.
Effective management of drug-food interactions is crucial for enhancing antibiotics' efficacy/safety. Adhering to PRISMA guidelines, we conducted a systematic review to assess the impact of dietary interventions on the bioavailability of 15 macrolides and 10 tetracyclines. We included studies examining the influence of food, beverages, antacids, and mineral supplements on the pharmacokinetic parameters of orally administered macrolides and tetracyclines. We searched Medline (via PubMed), Embase and Cochrane Library databases up to December 2022. Risk of bias was assessed using Cochrane and NIH tools. Quantitative analyses were conducted if two or more comparable food-effect studies were available; otherwise, a qualitative summary was provided. We included 120 studies from 97 reports. Meta-analyses were conducted for 8 macrolides and 4 tetracyclines, with qualitative synthesis for 10 and 9, respectively. About 64% of the studies were open-label, crossover designs. Our assessment found that 37% of the studies had a high risk of bias, while only 6% had low risk. Food significantly affected 10 of 13 macrolides (77%) and 6 of 7 tetracyclines (86%). High positive effects on bioavailability were seen with extended-release azithromycin and clarithromycin, and erythromycin estolate. High negative impacts were observed with erythromycin propionate and stearate, azithromycin capsules, demeclocycline and omadacycline. Antacids and mineral supplements significantly decreased tetracyclines absorption. Milk and grapefruit juice showed variable impacts on absorption. Interactions depend on antibiotics' physicochemical characteristics, intervention type, drug formulation and potential patient factors. The quality of evidence was rated low due to outdated studies, methodological diversity and unequal data availability.