tetracycline
Sources réglementaires consultées
Indications approuvées
- Infections prouvées ou fortement suspectées d’être dues à des bactéries sensibles, guidées par culture, sensibilité et épidémiologie locale.
Contre-indications
Absolues
- Hypersensibilité à toute tétracycline.
Mises en garde cliniques
- Mise en garde majeure · Éviter pendant le développement dentaire et avant 8 ans en raison d’une coloration permanente et d’une hypoplasie de l’émail. — FDA, set_id 00acf413-c5d2-4a54-9d0d-56266cbc9edc
- Mise en garde majeure · Elle peut s’accumuler en cas d’insuffisance rénale et provoquer azotémie, acidose ou hépatotoxicité ; réduire la dose ou espacer les prises. — FDA, set_id 00acf413-c5d2-4a54-9d0d-56266cbc9edc
- 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. — FDA, set_id 00acf413-c5d2-4a54-9d0d-56266cbc9edc
- Il peut provoquer une photosensibilité. Limiter l’exposition solaire/UV et arrêter en cas d’érythème important. — FDA, set_id 00acf413-c5d2-4a54-9d0d-56266cbc9edc
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.
FDA, set_id 00acf413-c5d2-4a54-9d0d-56266cbc9edc
- ModéréeAnticoagulants et pénicillines
Mécanisme: Elle peut augmenter l’anticoagulation et antagoniser les antibactériens bactéricides.
Recommandation: Surveiller l’INR et éviter l’association à la pénicilline si possible.
FDA, set_id 00acf413-c5d2-4a54-9d0d-56266cbc9edc
Effets indésirables
Communs (≥1%)
Nausées, vomissements, diarrhée, glossite et gêne épigastrique
Rares mais graves
Œsophagite ulcéreuse, insuffisance hépatique 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)
Atypical pneumonia is caused by atypical pathogens that are not detectable with Gram stain and cannot be cultured using standard methods. The most common causative organisms of atypical pneumonia are Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella species. The therapeutic approach for atypical pneumonias is different than that for typical pneumonia. Typical bacterial pathogens classically respond to β-lactam antimicrobial therapy because they have a cell wall amenable to β-lactam disruption. On the contrary, most atypical pathogens do not have a bacterial cell wall, some are intracellular (e.g., Legionella), and some are paracellular (e.g., M. pneumoniae). To prevent an increase in the number of antimicrobial-resistant strains, the Japanese pneumonia guidelines have proposed a differential diagnosis for typical bacterial pneumonia and atypical pneumonia to select an appropriate antibiotic for the management of mild-to-moderate pneumonia. The guidelines have set up six parameters and criteria based on the clinical symptoms, physical signs, and laboratory data. However, in the elderly individuals and patients with underlying diseases, the differential diagnosis may be difficult or a mixed infection may be latent. Therefore, in these individuals, the administration of a β-lactam drug plus a macrolide or tetracycline, or only fluoroquinolone should be considered from the beginning to cover bacterial and atypical pneumonia.
Mycoplasma pneumoniae (MP) is the cause of Mycoplasma pneumoniae pneumonia (MPP) in children and adolescents, with the clinical manifestations highlighted by intermittent irritating cough, accompanied by headache, fever and muscle pain. This paper aimed to study the research status and focal points in MP infection, especially the common laboratory diagnostic methods and clinical treatment of Mycoplasma pneumoniae. Laboratory diagnostic methods include molecular assay, serological antibody detection, rapid antigen detection and isolation and culture. Polymerase chain reaction (PCR) is the gold standard with high sensitivity and specificity. The serological antibody can detect various immune antibodies qualitatively or quantitatively in serum. Rapid antigen can be detected faster, with no equipment environment requirements, which can be used for the early diagnosis of MP infection. While the culture growth cycle is long and insensitive, not recommended for routine diagnosis. Macrolides were the preferred drug for children with MPP, while the drug resistance rate was rising in China. Tetracycline can be substituted but was not recommended for children under 8 years of age, quinolone drugs are not necessary, severe MPP can be combined with glucocorticoids, involving the nervous or immune system can choose gamma globulin. Other treatments for MPP including symptomatic treatment which can alleviate symptoms, improve lung function and improve prognosis. A safe and effective vaccine needed to be developed which can provide protective immunity to children and will reduce the incidence of MPP.
Interventions to reduce sexually transmitted infections (STIs) among men who have sex with men (MSM) are needed. We conducted an open-label, randomized study involving MSM and transgender women who were taking preexposure prophylaxis (PrEP) against human immunodeficiency virus (HIV) infection (PrEP cohort) or living with HIV infection (persons living with HIV infection [PLWH] cohort) and who had had Neisseria gonorrhoeae (gonorrhea), Chlamydia trachomatis (chlamydia), or syphilis in the past year. Participants were randomly assigned in a 2:1 ratio to take 200 mg of doxycycline within 72 hours after condomless sex (doxycycline postexposure prophylaxis) or receive standard care without doxycycline. STI testing was performed quarterly. The primary end point was the incidence of at least one STI per follow-up quarter. Of 501 participants (327 in the PrEP cohort and 174 in the PLWH cohort), 67% were White, 7% Black, 11% Asian or Pacific Islander, and 30% Hispanic or Latino. In the PrEP cohort, an STI was diagnosed in 61 of 570 quarterly visits (10.7%) in the doxycycline group and 82 of 257 quarterly visits (31.9%) in the standard-care group, for an absolute difference of -21.2 percentage points and a relative risk of 0.34 (95% confidence interval [CI], 0.24 to 0.46; P<0.001). In the PLWH cohort, an STI was diagnosed in 36 of 305 quarterly visits (11.8%) in the doxycycline group and 39 of 128 quarterly visits (30.5%) in the standard-care group, for an absolute difference of -18.7 percentage points and a relative risk of 0.38 (95% CI, 0.24 to 0.60; P<0.001). The incidences of the three evaluated STIs were lower with doxycycline than with standard care; in the PrEP cohort, the relative risks were 0.45 (95% CI, 0.32 to 0.65) for gonorrhea, 0.12 (95% CI, 0.05 to 0.25) for chlamydia, and 0.13 (95% CI, 0.03 to 0.59) for syphilis, and in the PLWH cohort, the relative risks were 0.43 (95% CI, 0.26 to 0.71), 0.26 (95% CI, 0.12 to 0.57), and 0.23 (95% CI, 0.04 to 1.29), respectivel
Various treatments for acne vulgaris exist, but little is known about their comparative effectiveness in relation to acne severity. To identify best treatments for mild-to-moderate and moderate-to-severe acne, as determined by clinician-assessed morphological features. We undertook a systematic review and network meta-analysis of randomized controlled trials (RCTs) assessing topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, published up to May 2020. Outcomes included percentage change in total lesion count from baseline, treatment discontinuation for any reason, and discontinuation owing to side-effects. Risk of bias was assessed using the Cochrane risk-of-bias tool and bias adjustment models. Effects for treatments with ≥ 50 observations each compared with placebo are reported below. We included 179 RCTs with approximately 35 000 observations across 49 treatment classes. For mild-to-moderate acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with benzoyl peroxide (BPO) [mean difference 26·16%, 95% credible interval (CrI) 16·75-35·36%]; physical - chemical peels, e.g. salicylic or mandelic acid (39·70%, 95% CrI 12·54-66·78%) and photochemical therapy (combined blue/red light) (35·36%, 95% CrI 17·75-53·08%). Oral pharmacological treatments (e.g. antibiotics, hormonal contraceptives) did not appear to be effective after bias adjustment. BPO and topical retinoids were less well tolerated than placebo. For moderate-to-severe acne, the most effective options for each treatment type were as follows: topical pharmacological - combined retinoid with lincosamide (clindamycin) (44·43%, 95% CrI 29·20-60·02%); oral pharmacological - isotretinoin of total cumulative dose ≥ 120 mg kg-1 per single course (58·09%, 95% CrI 36·99-79·29%); physical - photodynamic therapy (light therapy enhanced by a photosensitizing chemical) (40·45%, 95% C