Tetracycline

Tetracycline is a broad-spectrum antibiotic from the tetracycline class that is used orally for moderate to severe inflammatory acne. It is used when topical antibiotics alone are not sufficiently effective.

Tetracyclines have been used in acne treatment for decades. In addition to their antibacterial effect, they also have anti-inflammatory properties that contribute to improving acne independently of the antibacterial effect.

In practice, doxycycline or minocycline, as more modern tetracyclines, are used more often today, but tetracycline remains an option.

Tetracycline has antibacterial and anti-inflammatory effects:

Antibacterial effect:

• Inhibits bacterial protein synthesis (30S ribosome)
• Bacteriostatic against Cutibacterium acnes
• Reduces the bacterial load in the sebaceous glands

Anti-inflammatory effect:

• Inhibits matrix metalloproteinases
• Reduces neutrophil chemotaxis
• Inhibits the production of pro-inflammatory cytokines
• This effect is also present at sub-antibiotic doses

Time course:

• First improvement: 4-6 weeks
• Optimal effect: 8-12 weeks

Tetracycline is suitable for:

• Moderate to severe inflammatory acne
• Papulopustular acne
• When topical treatment is not enough

Always in combination with:

• Topical treatment (benzoyl peroxide and/or retinoid)
• Not as monotherapy

Not suitable:

• Pregnancy and breastfeeding
• Children under 8 years of age (tooth discoloration)
• Mild acne (topical treatment first)

Tetracycline tablets/capsules:

• 250-500 mg 2x daily
• Treatment duration: 6-12 weeks
• Maximum: 3 months, then review the treatment

Note on taking it:

• Take on an empty stomach (1 hour before or 2 hours after eating)
• Do not take with dairy products!

How to take:

• 1 hour before eating OR 2 hours after eating
• With a large glass of water
• Stay upright (do not lie down right away)

Important – interactions with food:

• NO milk, yogurt, cheese (calcium binds tetracycline)
• NO iron, magnesium, aluminum (antacids)
• These substances prevent absorption in the gut

Additionally:

• Always together with topical treatment (benzoyl peroxide, retinoid)
• Use sun protection (photosensitization!)

Contraindicated in:

• Pregnancy (tooth discoloration and impaired bone growth in the child)
• Breastfeeding
• Children under 8 years of age
• Severe liver or kidney impairment

Caution in:

• Myasthenia gravis
• Systemic lupus erythematosus

Contraception: Tetracyclines can reduce the effectiveness of oral contraceptives! An additional method of contraception is recommended.

Common:

• Gastrointestinal complaints (nausea, diarrhea)
• Photosensitization (sensitivity to sunburn)
• Vaginal fungal infections

Uncommon:

• Headache
• Dizziness
• Esophagitis (with insufficient fluid intake)

Rare:

• Tooth discoloration (in children/pregnant women)
• Pseudotumor cerebri (increased intracranial pressure)
• Hepatotoxicity

Prevention: Drink enough water, use sun protection.

Interactions:

• Antacids (aluminum, magnesium, calcium) – reduced absorption
• Dairy products – reduced absorption
• Iron supplements – reduced absorption
• Oral contraceptives – possibly reduced effectiveness
• Isotretinoin – do NOT combine (pseudotumor cerebri)
• Methotrexate – increased toxicity

Time interval: Leave at least 2 hours between tetracycline and antacids, iron, or dairy products.