Dose adjustments ▶ In adults Use half normal dose if eGFR
▶ In children Use half normal dose if estimated glomerular
filtration rate 15–30 mL/minute/1.73 m2
▶ Monitor blood counts on prolonged treatment.
▶ In children Plasma concentration monitoring may be
required with high doses; seek expert advice.
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use in children For intermittent intravenous
infusion, may be further diluted in glucose 5% and 10% or
sodium chloride 0.9%. Dilute contents of 1 ampoule (5 mL)
to 125 mL, 2 ampoules (10 mL) to 250 mL or 3 ampoules
(15 mL) to 500 mL; suggested duration of infusion
60–90 minutes (but may be adjusted according to fluid
requirements); if fluid restriction necessary, 1 ampoule
(5 mL) may be diluted with 75 mL glucose 5% and the
required dose infused over max. 60 minutes; check
container for haze or precipitant during administration. In
severe fluid restriction may be given undiluted via a
▶ With intravenous use in adults For intravenous infusion
(Septrin ® for infusion), give intermittently in Glucose 5% or
10% or Sodium chloride 0.9%. Dilute contents of
1 ampoule (5 mL) to 125 mL, 2 ampoules (10 mL) to 250 mL
or 3 ampoules (15 mL) to 500 mL; suggested duration of
infusion 60–90 minutes (but may be adjusted according to
fluid requirements); if fluid restriction necessary,
1 ampoule (5 mL) may be diluted with 75 mL glucose 5%
and infused over max. 60 minutes.
l PRESCRIBING AND DISPENSING INFORMATION Cotrimoxazole is a mixture of trimethoprim and
sulfamethoxazole (sulphamethoxazole) in the proportions
Flavours of oral liquid formulations may include banana,
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
EXCIPIENTS: May contain Alcohol, propylene glycol, sulfites
ELECTROLYTES: May contain Sodium
▶ Co-trimoxazole (Non-proprietary)
Trimethoprim 16 mg per 1 ml, Sulfamethoxazole 80 mg per
1 ml Co-trimoxazole 80mg/400mg/5ml solution for infusion ampoules
| 10 ampoule P £35.00 DT = £35.00
CAUTIONARY AND ADVISORY LABELS 9
▶ Co-trimoxazole (Non-proprietary)
Trimethoprim 8 mg per 1 ml, Sulfamethoxazole 40 mg per
1 ml Co-trimoxazole 40mg/200mg/5ml oral suspension sugar free
sugar-free | 100 ml P £9.95–£9.96 DT = £9.96
Trimethoprim 16 mg per 1 ml, Sulfamethoxazole 80 mg per
1 ml Co-trimoxazole 80mg/400mg/5ml oral suspension | 100 ml P £10.95–£10.96 DT = £10.96
CAUTIONARY AND ADVISORY LABELS 9
▶ Co-trimoxazole (Non-proprietary)
Trimethoprim 80 mg, Sulfamethoxazole 400 mg Co-trimoxazole
80mg/400mg tablets | 28 tablet P £15.50 DT = £2.01 | 100 tablet P £7.18–£10.91
Trimethoprim 160 mg, Sulfamethoxazole 800 mg Co-trimoxazole
160mg/800mg tablets | 100 tablet P £23.40–£23.46 DT = £23.46
l DRUG ACTION Sulfadiazine is a short-acting sulphonamide
with bacteriostatic activity against a broad spectrum of
organisms. The importance of the sulfonamides has
decreased as a result of increasing bacterial resistance and
their replacement by antibacterials which are generally
Prevention of rheumatic fever recurrence
▶ Adult (body-weight up to 30 kg): 500 mg daily
▶ Adult (body-weight 30 kg and above): 1 g daily
Sulfadiazine has been confused with sulfasalazine; care
must be taken to ensure the correct drug is prescribed
l CONTRA-INDICATIONS Acute porphyrias p. 1058
l CAUTIONS Asthma . avoid in blood disorders (unless under
specialist supervision). avoid in infants under 6 weeks
(except for treatment or prophylaxis of pneumocystis
adequate fluid intake . predisposition to folate deficiency . predisposition to hyperkalaemia
l INTERACTIONS → Appendix 1: sulfonamides
▶ Rare or very rare Haemolytic anaemia
adverse reactions (SCARs). skin reactions . systemic lupus
erythematosus (SLE).thrombocytopenia .tinnitus . vasculitis . vertigo . vomiting
SIDE-EFFECTS, FURTHER INFORMATION Discontinue
immediately if blood disorders (including leucopenia,
thrombocytopenia, megaloblastic anaemia, eosinophilia)
or rash (including Stevens-Johnson syndrome, toxic
epidermal necrolysis) develop.
l PREGNANCY Risk of neonatal haemolysis and
methaemoglobinaemia in third trimester; fear of increased
risk of kernicterus in neonates appears to be unfounded.
l BREAST FEEDING Small risk of kernicterus in jaundiced
infants and of haemolysis in G6PD-deficient infants.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild to moderate impairment; avoid in severe impairment
l RENAL IMPAIRMENT Use with caution in mild to moderate
impairment; avoid in severe impairment; high risk of
l MONITORING REQUIREMENTS Monitor blood counts on
BNF 78 Bacterial infection 563
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
CAUTIONARY AND ADVISORY LABELS 9, 27
▶ Sulfadiazine (Non-proprietary)
Sulfadiazine 500 mg Sulfadiazine 500mg tablets | 56 tablet P £206.13 DT = £200.68
ANTIBACTERIALS › TETRACYCLINES AND
The tetracyclines are broad-spectrum antibiotics whose
value has decreased owing to increasing bacterial resistance.
They remain, however, the treatment of choice for infections
caused by chlamydia (trachoma, psittacosis, salpingitis,
urethritis, and lymphogranuloma venereum), rickettsia
(including Q-fever), brucella (doxycycline below with either
streptomycin p. 520 or rifampicin p. 582), and the
spirochaete, Borrelia burgdorferi (See Lyme disease). They are
also used in respiratory and genital mycoplasma infections,
in acne, in destructive (refractory) periodontal disease, in
exacerbations of chronic bronchitis (because of their activity
against Haemophilus influenzae), and for leptospirosis in
penicillin hypersensitivity (as an alternative to erythromycin
Microbiologically, there is little to choose between the
various tetracyclines, the only exception being minocycline
p. 566 which has a broader spectrum; it is active against
Neisseria meningitidis and has been used for meningococcal
tetracyclines, minocycline is associated with a greater risk of
lupus-erythematosus-like syndrome. Minocycline
sometimes causes irreversible pigmentation.
l CAUTIONS Myasthenia gravis (muscle weakness may be
increased). systemic lupus erythematosus (may be
reactions . systemic lupus erythematosus exacerbated . vomiting
▶ Rare or very rare Appetite decreased . discolouration of
thyroid gland . dysphagia . eosinophilia . fontanelle
▶ Frequency not known Dizziness .tooth discolouration
SIDE-EFFECTS, FURTHER INFORMATION Headache and
visual disturbances may indicate benign intracranial
hypertension (discontinue treatment if raised intracranial
l PREGNANCY Should not be given to pregnant women;
effects on skeletal development have been documented in
the first trimester in animal studies. Administration during
the second or third trimester may cause discoloration of
the child’s teeth, and maternal hepatotoxicity has been
reported with large parenteral doses.
l BREAST FEEDING Should not be given to women who are
breast-feeding (although absorption and therefore
discoloration of teeth in the infant is probably usually
prevented by chelation with calcium in milk).
l HEPATIC IMPAIRMENT Should be avoided or used with
caution in patients with hepatic impairment.
Demeclocycline hydrochloride 14-Nov-2018
Susceptible infections (e.g. chlamydia, rickettsia and
▶ Adult: 150 mg 4 times a day, alternatively 300 mg twice
Treatment of hyponatraemia resulting from inappropriate
secretion of antidiuretic hormone, if fluid restriction
alone does not restore sodium concentration or is not
▶ Adult: Initially 0.9–1.2 g daily in divided doses,
l CAUTIONS Photosensitivity more common than with other
l INTERACTIONS → Appendix 1: tetracyclines
Dose adjustments Max. 1 g daily in divided doses.
l RENAL IMPAIRMENT May exacerbate renal failure and
should not be given to patients with renal impairment.
l PATIENT AND CARER ADVICE Patients should be advised to
avoid exposure to sunlight or sun lamps.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: tablet, oral
▶ Demeclocycline hydrochloride (Non-proprietary)
Demeclocycline hydrochloride 150 mg Demeclocycline 150mg
CAUTIONARY AND ADVISORY LABELS 7, 9, 11, 23
▶ Demeclocycline hydrochloride (Non-proprietary)
Demeclocycline hydrochloride 150 mg Demeclocycline 150mg
capsules | 28 capsule P £200.66 DT = £200.66
Susceptible infections (e.g. chlamydia, rickettsia and
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: Initially 200 mg daily in 1–2 divided
doses for 1 day, then maintenance 100 mg daily
▶ Adult: Initially 200 mg daily in 1–2 divided doses for
1 day, then maintenance 100 mg daily
564 Bacterial infection BNF 78
Acute sinusitis | Acute cough [if systemically very unwell
or at higher risk of complications]
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: Initially 200 mg daily for 1 dose, then
maintenance 100 mg once daily for 5 days in total
▶ Adult: Initially 200 mg daily for 1 dose, then
maintenance 100 mg once daily for 5 days in total
Acute exacerbation of bronchiectasis
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: Initially 200 mg daily for 1 dose, then
maintenance 100 mg once daily for 7–14 days in total
▶ Adult: Initially 200 mg daily for 1 dose, then
maintenance 100 mg once daily for 7–14 days in total
Acute exacerbation of chronic obstructive pulmonary
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: Initially 200 mg daily for 1 dose, then
maintenance 100 mg once daily for 5 days in total,
increased if necessary to 200 mg once daily, increased
dose used in severe infections
Severe infections (including refractory urinary-tract
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 200 mg daily
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg once daily
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
Papulopustular facial rosacea (without ocular
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Adult: 40 mg once daily for 16 weeks, dose to be taken
in the morning, consider discontinuing treatment if no
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg twice daily for 14 days
▶ Adult: 100 mg twice daily for 14 days
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg twice daily for 28 days
▶ Adult: 100 mg twice daily for 28 days
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: 200 mg twice daily for 28 days
Uncomplicated genital chlamydia | Non-gonococcal
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg twice daily for 7 days
▶ Adult: 100 mg twice daily for 7 days
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg twice daily for 14 days
▶ Adult: 100 mg twice daily for 14 days
Lyme disease [erythema migrans and/or non-focal
symptoms]| Lyme disease [affecting cranial nerves or
peripheral nervous system]| Lyme carditis
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: 200 mg daily in 1–2 divided doses for 21 days
Lyme disease [affecting central nervous system]
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: 400 mg daily in 1–2 divided doses for 21 days
Lyme arthritis | Acrodermatitis chronica atrophicans
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: 200 mg daily in 1–2 divided doses for 28 days
Anthrax (treatment or post-exposure prophylaxis)
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg twice daily
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg once daily, to be started
1–2 days before entering endemic area and continued
for 4 weeks after leaving, can be used for up to 2 years
▶ Adult: 100 mg once daily, to be started 1–2 days before
entering endemic area and continued for 4 weeks after
leaving, can be used for up to 2 years
Adjunct to quinine in treatment of Plasmodium
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 200 mg daily for 7 days
▶ Adult: 200 mg daily for 7 days
Periodontitis (as an adjunct to gingival scaling and root
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 20 mg twice daily for 3 months
▶ Adult: 20 mg twice daily for 3 months
▶ BY MOUTH USING DISPERSIBLE TABLETS
▶ Adult: 100 mg twice daily, continue treatment for at
least 3 days after fever subsides, minimum treatment
l UNLICENSED USE Doxycycline may be used as detailed
below, although these situations are considered outside
. g Duration of treatment for acute sinusitis h, see
Sinusitis (acute) p. 1203 for further information;
. treatment or post-exposure prophylaxis of anthrax;
. malaria prophylaxis during pregnancy;
. recurrent aphthous ulceration.
▶ In adults Immediate-release doxycycline may be used for
the treatment of rosacea, but it is not licensed for this
l INTERACTIONS → Appendix 1: tetracyclines
▶ Common or very common Dyspnoea . hypotension . peripheral oedema .tachycardia
▶ Uncommon Gastrointestinal discomfort
(SCARs). skin hyperpigmentation (long term use). tinnitus . vision disorders
l PREGNANCY When travel to malarious areas is
unavoidable during pregnancy, doxycycline can be used
for malaria prophylaxis if other regimens are unsuitable,
and if the entire course of doxycycline can be completed
l RENAL IMPAIRMENT Use with caution (avoid excessive
l MONITORING REQUIREMENTS When used for periodontitis,
monitor for superficial fungal infection, particularly if
predisposition to oral candidiasis.
l DIRECTIONS FOR ADMINISTRATION Capsules and Tablets
should be swallowed whole with plenty of fluid, while
sitting or standing. Capsules should be taken during meals.
l PRESCRIBING AND DISPENSING INFORMATION See Lyme
disease p. 577 for place in therapy and further information
l PATIENT AND CARER ADVICE Counselling on
BNF 78 Bacterial infection 565
Photosensitivity Patients should be advised to avoid
exposure to sunlight or sun lamps.
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Doxycycline Capsules 100 mg may be prescribed.
Dispersible tablets may be prescribed as Dispersible
Tablets may be prescribed as Doxycycline Tablets 20 mg.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 6, 11, 27
▶ Periostat (Alliance Pharmaceuticals Ltd)
Doxycycline (as Doxycycline hyclate) 20 mg Periostat 20mg tablets
| 56 tablet P £17.30 DT = £17.30
CAUTIONARY AND ADVISORY LABELS 6, 9, 11, 13
Doxycycline (as Doxycycline monohydrate) 100 mg Vibramycin-D
100mg dispersible tablets sugar-free | 8 tablet P £4.91 DT = £4.91
CAUTIONARY AND ADVISORY LABELS 6, 11, 27
Doxycycline (as Doxycycline monohydrate) 40 mg Efracea 40mg
modified-release capsules | 14 capsule P £7.99 DT = £7.99 |
CAUTIONARY AND ADVISORY LABELS 6, 9, 11, 27
▶ Doxycycline (Non-proprietary)
Doxycycline (as Doxycycline hyclate) 50 mg Doxycycline 50mg
capsules | 28 capsule P £4.00 DT = £1.21
Doxycycline (as Doxycycline hyclate) 100 mg Doxycycline 100mg
capsules | 8 capsule P £3.00 DT = £0.76 | 14 capsule P £5.25
Susceptible infections (e.g. chlamydia, rickettsia and
▶ Child 12–17 years: 408 mg twice daily, increased to
1.224–1.632 g daily, (in severe infection)
▶ Adult: 408 mg twice daily, increased to 1.224–1.632 g
▶ Child 12–17 years: 408 mg daily for at least 8 weeks
▶ Adult: 408 mg daily for at least 8 weeks
l INTERACTIONS → Appendix 1: tetracyclines
▶ Common or very common Gastrointestinal discomfort
▶ Frequency not known Visual impairment
l RENAL IMPAIRMENT May exacerbate renal failure and
should not be given to patients with renal impairment.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 6, 9
▶ Lymecycline (Non-proprietary)
Lymecycline 408 mg Lymecycline 408mg capsules |
28 capsule P £6.95 DT = £4.23 | 56 capsule P £8.46–£11.66
▶ Tetralysal (Galderma (UK) Ltd)
Lymecycline 408 mg Tetralysal 300 capsules | 28 capsule P £6.95 DT = £4.23 | 56 capsule P £11.53
Susceptible infections (e.g. chlamydia, rickettsia and
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg twice daily
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg once daily, alternatively 50 mg
▶ Adult: 100 mg once daily, alternatively 50 mg twice
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Child 12–17 years: 100 mg daily
Prophylaxis of asymptomatic meningococcal carrier state
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: 100 mg twice daily for 5 days, minocycline
treatment is usually followed by administration of
l CAUTIONS Systemic lupus erythematosus
l INTERACTIONS → Appendix 1: tetracyclines
▶ Rare or very rare Acute kidney injury . hearing impairment .respiratory disorders .tinnitus
▶ Frequency not known Alopecia . antibiotic associated
colitis . arthralgia . ataxia . breast secretion . conjunctival
discolouration . drug reaction with eosinophilia and
l RENAL IMPAIRMENT Use with caution (avoid excessive
l MONITORING REQUIREMENTS If treatment continued for
longer than 6 months, monitor every 3 months for
hepatotoxicity, pigmentation and for systemic lupus
erythematosus—discontinue if these develop or if preexisting systemic lupus erythematosus worsens.
l DIRECTIONS FOR ADMINISTRATION Tablets or capsules
should be swallowed whole with plenty of fluid while
l PATIENT AND CARER ADVICE Counselling on
administration advised (posture).
l LESS SUITABLE FOR PRESCRIBING Less suitable for
prescribing (compared with other tetracyclines,
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
CAUTIONARY AND ADVISORY LABELS 6, 9
▶ Minocycline (Non-proprietary)
Minocycline (as Minocycline hydrochloride) 50 mg Minocycline
50mg tablets | 28 tablet P £8.50 DT = £6.19
Minocycline (as Minocycline hydrochloride) 100 mg Minocycline
100mg tablets | 28 tablet P £14.50 DT = £14.16
CAUTIONARY AND ADVISORY LABELS 6, 25
▶ Minocycline (Non-proprietary)
Minocycline (as Minocycline hydrochloride) 100 mg Minocycline
100mg modified-release capsules | 56 capsule P £20.08 DT =
566 Bacterial infection BNF 78
▶ Acnamino MR (Dexcel-Pharma Ltd)
Minocycline (as Minocycline hydrochloride) 100 mg Acnamino MR
100mg capsules | 56 capsule P £21.14 DT = £20.08
▶ Minocin MR (Meda Pharmaceuticals Ltd)
Minocycline (as Minocycline hydrochloride) 100 mg Minocin MR
100mg capsules | 56 capsule P £20.08 DT = £20.08
CAUTIONARY AND ADVISORY LABELS 6, 9
Minocycline (as Minocycline hydrochloride) 50 mg Aknemin 50
capsules | 56 capsule P £15.27 DT = £15.27
Minocycline (as Minocycline hydrochloride) 100 mg Aknemin
100mg capsules | 28 capsule P £13.09 DT = £13.09
Susceptible infections (e.g. chlamydia, rickettsia and
▶ Child 12–17 years: 250–500 mg 4 times a day
▶ Adult: 250–500 mg 4 times a day
▶ Adult: 500 mg twice daily usually for 6–12 weeks
(course may be repeated intermittently)
▶ Child 12–17 years: 500 mg twice daily for at least
3 months, if there is no improvement after the first
3 months another oral antibacterial should be used,
maximum improvement usually occurs after 4 to
6 months but in more severe cases treatment may need
to be continued for 2 years or longer
▶ Adult: 500 mg twice daily for at least 3 months, if there
is no improvement after the first 3 months another oral
antibacterial should be used, maximum improvement
usually occurs after 4 to 6 months but in more severe
cases treatment may need to be continued for 2 years
l INTERACTIONS → Appendix 1: tetracyclines
l SIDE-EFFECTS Gastrointestinal discomfort.renal
l RENAL IMPAIRMENT May exacerbate renal failure and
should not be given to patients with renal impairment.
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Oxytetracycline Tablets may be prescribed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
CAUTIONARY AND ADVISORY LABELS 7, 9, 23
▶ Oxytetracycline (Non-proprietary)
Oxytetracycline (as Oxytetracycline dihydrate)
250 mg Oxytetracycline 250mg tablets | 28 tablet P £0.79 DT =
Susceptible infections (e.g. chlamydia, rickettsia,
▶ Child 12–17 years: 250 mg 4 times a day, increased if
necessary to 500 mg 3–4 times a day, increased dose
▶ Adult: 250 mg 4 times a day, increased if necessary to
500 mg 3–4 times a day, increased dose used in severe
▶ Adult: 500 mg twice daily usually for 6–12 weeks
(course may be repeated intermittently)
▶ Child 12–17 years: 500 mg twice daily for at least
3 months, if there is no improvement after the first
3 months another oral antibacterial should be used,
maximum improvement usually occurs after 4 to
6 months but in more severe cases treatment may need
to be continued for 2 years or longer
▶ Adult: 500 mg twice daily for at least 3 months, if there
is no improvement after the first 3 months another oral
antibacterial should be used, maximum improvement
usually occurs after 4 to 6 months but in more severe
cases treatment may need to be continued for 2 years
Diabetic diarrhoea in autonomic neuropathy
▶ Adult: 250 mg for 2 or 3 doses
▶ Child 12–17 years: 500 mg 4 times a day for 7–14 days
(21 days if failure or relapse after first course)
▶ Adult: 500 mg 4 times a day for 7–14 days (21 days if
failure or relapse after first course)
l UNLICENSED USE Not licensed for treatment of diabetic
diarrhoea in autonomic neuropathy.
l INTERACTIONS → Appendix 1: tetracyclines
▶ Rare or very rare Agranulocytosis . aplastic anaemia . nephritis .renal impairment
▶ Frequency not known Gastrointestinal discomfort.toxic
Dose adjustments Max. 1 g daily in divided doses.
l RENAL IMPAIRMENT May exacerbate renal failure and
should not be given to patients with renal impairment.
l DIRECTIONS FOR ADMINISTRATION Tablets should be
swallowed whole with plenty of fluid while sitting or
l PATIENT AND CARER ADVICE Counselling on
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Tetracycline Tablets may be prescribed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: capsule, oral
CAUTIONARY AND ADVISORY LABELS 7, 9, 23
▶ Tetracycline (Non-proprietary)
Tetracycline hydrochloride 250 mg Tetracycline 250mg tablets |
BNF 78 Bacterial infection 567
l DRUG ACTION Tigecycline is a glycylcycline antibacterial
structurally related to the tetracyclines. Tigecycline is
active against Gram-positive and Gram-negative bacteria,
including tetracycline-resistant organisms, and some
anaerobes. It is also active against meticillin-resistant
Staphylococcus aureus and vancomycin-resistant
enterococci, but Pseudomonas aeruginosa and many strains
of Proteus spp are resistant to tigecycline.
Complicated skin and soft tissue infections (when other
antibiotics are not suitable)| Complicated intraabdominal infections (when other antibiotics are not
▶ Adult: Initially 100 mg, followed by 50 mg every
l CONTRA-INDICATIONS Diabetic foot infections
l INTERACTIONS → Appendix 1: tetracyclines
infection . nausea . sepsis . skin reactions . vomiting
▶ Uncommon Hepatic disorders . pancreatitis . thrombocytopenia .thrombophlebitis
▶ Frequency not known Acidosis . azotaemia . hyperphosphataemia . hypofibrinogenaemia . idiopathic
adverse reactions (SCARs).tooth discolouration
SIDE-EFFECTS, FURTHER INFORMATION Side-effects similar
to those of the tetracyclines can potentially occur.
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated in
patients hypersensitive to tetracyclines.
l PREGNANCY Tetracyclines should not be given to
pregnant women; effects on skeletal development have
been documented in the first trimester in animal studies.
Administration during the second or third trimester may
cause discoloration of the child’s teeth, and maternal
hepatotoxicity has been reported with large parenteral
l BREAST FEEDING Manufacturer advises avoid—present in
l HEPATIC IMPAIRMENT Manufacturer advises caution in
Dose adjustments Manufacturer advises dose reduction to
25 mg every 12 hours following the loading dose in severe
l DIRECTIONS FOR ADMINISTRATION For intravenous infusion
(Tygacil ®), give intermittently in Glucose 5% or Sodium
Chloride 0.9%. Reconstitute each vial with 5.3 mL infusion
fluid to produce a 10 mg/mL solution; dilute requisite dose
in 100 mL infusion fluid; give over 30–60 minutes.
Driving and skilled tasks Manufacturer advises patients and
carers should be cautioned on the effects on driving and
performance of skilled tasks—increased risk of dizziness.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder for solution for infusion
▶ Tigecycline (Non-proprietary)
Tigecycline 50 mg Tigecycline 50mg powder for solution for infusion
vials | 10 vial P £290.79 (Hospital only)
Tigecycline 50 mg Tygacil 50mg powder for solution for infusion
vials | 10 vial P £323.10 (Hospital only)
ANTIBACTERIALS › ANTIBACTERIALS, OTHER
l DRUG ACTION Chloramphenicol is a potent broadspectrum antibiotic.
Life threatening infections particularly those caused by
Haemophilus influenzae | Typhoid fever
▶ BY MOUTH, OR BY INTRAVENOUS INJECTION, OR BY
▶ Adult: 12.5 mg/kg every 6 hours, in exceptional cases
dose can be doubled for severe infections such as
septicaemia and meningitis, providing high doses
reduced as soon as clinically indicated
l CONTRA-INDICATIONS Acute porphyrias p. 1058
l CAUTIONS Avoid repeated courses and prolonged
l INTERACTIONS → Appendix 1: chloramphenicol
▶ With parenteral use Aplastic anaemia (reversible or
irreversible, with reports of resulting leukaemia)
disorders . ototoxicity . vomiting
▶ With parenteral use Agranulocytosis . bone marrow
disorders . depression . diarrhoea . dry mouth . fungal
SIDE-EFFECTS, FURTHER INFORMATION Associated with
serious haematological side-effects when given
systemically and should therefore be reserved for the
treatment of life-threatening infections.
l PREGNANCY Manufacturer advises avoid; neonatal ‘greybaby syndrome’ if used in third trimester.
l BREAST FEEDING Manufacturer advises avoid; use another
antibiotic; may cause bone-marrow toxicity in infant;
concentration in milk usually insufficient to cause ‘grey
l HEPATIC IMPAIRMENT Avoid if possible—increased risk of
Monitoring Monitor plasma-chloramphenicol
concentration in hepatic impairment.
l RENAL IMPAIRMENT Avoid in severe renal impairment
unless no alternative; dose-related depression of
▶ Plasma concentration monitoring preferred in the elderly.
▶ Recommended peak plasma concentration (approx.
2 hours after administration by mouth, intravenous
injection or infusion) 10–25 mg/litre; pre-dose (‘trough’)
concentration should not exceed 15 mg/litre.
▶ Blood counts required before and periodically during
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intravenous infusion, give
intermittently or via drip tubing in Glucose 5% or Sodium
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