Tetracycline

Tetracyclines have a broad spectrum of antibiotic action. Originally, they possessed some level of bacteriostatic activity against almost all medically relevant aerobic and anaerobic bacterial genera, both Gram-positive and Gram-negative, with a few exceptions, such as Pseudomonas aeruginosa and Proteus spp., which display intrinsic resistance. However, acquired (as opposed to inherent) resistance has proliferated in many pathogenic organisms and greatly eroded the formerly vast versatility of this group of antibiotics. Resistance amongst Staphylococcus spp., Streptococcus spp., Neisseria gonorrhoeae, anaerobes, members of the Enterobacteriaceae, and several other previously sensitive organisms is now quite common. Tetracyclines remain especially useful in the management of infections by certain obligately intracellular bacterial pathogens such as Chlamydia, Mycoplasma, and Rickettsia. They are also of value in spirochaetal infections, such as syphilis, and Lyme disease. Certain rare or exotic infections, including anthrax, plague, and brucellosis, are also susceptible to tetracyclines. Tetracycline tablets were used in the plague outbreak in India in 1994.Lippincott's Illustrated Reviews: Pharmacology, 4th ed. Harvery RA, Champe, PC. Lippincott, Williams & Wilkins, 2009 Tetracycline is first-line therapy for Rocky Mountain spotted fever (Rickettsia), Lyme disease (B. burgdorferi), Q fever (Coxiella), psittacosis, Mycoplasma pneumoniae, and nasal carriage of meningococci.{{cn|date=March 2023}}

It is also one of a group of antibiotics which together may be used to treat peptic ulcers caused by bacterial infections. The mechanism of action for the antibacterial effect of tetracyclines relies on disrupting protein translation in bacteria, thereby damaging the ability of microbes to grow and repair; however, protein translation is also disrupted in eukaryotic mitochondria leading to effects that may confound experimental results.{{Cite journal |vauthors=Moullan N, Mouchiroud L, Wang X, Ryu D, Williams EG, Mottis A, Jovaisaite V, Frochaux MV, Quiros PM, Deplancke B, Houtkooper RH, Auwerx J |date=March 2015 |title=Tetracyclines Disturb Mitochondrial Function across Eukaryotic Models: A Call for Caution in Biomedical Research |journal=Cell Reports |volume=10 |issue=10 |pages=1681–1691 |doi=10.1016/j.celrep.2015.02.034 |pmc=4565776 |pmid=25772356}}{{Cite journal |vauthors=Chatzispyrou IA, Held NM, Mouchiroud L, Auwerx J, Houtkooper RH |date=November 2015 |title=Tetracycline antibiotics impair mitochondrial function and its experimental use confounds research |journal=Cancer Research |volume=75 |issue=21 |pages=4446–4449 |doi=10.1158/0008-5472.CAN-15-1626 |pmc=4631686 |pmid=26475870}}

The following list presents MIC susceptibility data for some medically significant microorganisms:

• Escherichia coli: 1 {{abbr|μg|microgram}}/{{abbr|mL|mililiter}} to >128 μg/mL
• Shigella {{abbr|spp.|subspecies}}: 1 μg/mL to 128 μg/mL{{Cite web |date=8 September 2015 |title=Tetracycline hydrochloride |url=http://www.toku-e.com/Assets/MIC/Tetracycline%20hydrochloride.pdf |archive-url=https://web.archive.org/web/20150908102809/http://www.toku-e.com/Assets/MIC/Tetracycline%20hydrochloride.pdf |archive-date=8 September 2015 |website=Susceptibility and Minimum Inhibitory Concentration (MIC) Data |publisher=TOKU-E}}

The tetracyclines also have activity against certain eukaryotic parasites, including those responsible for diseases such as dysentery caused by an amoeba, malaria (a plasmodium), and balantidiasis (a ciliate).{{cn|date=March 2023}}

File:Tetracycline-HCl substance photo.jpg

Since tetracycline is absorbed into bone, it is used as a marker of bone growth for biopsies in humans. Tetracycline labeling is used to determine the amount of bone growth within a certain period of time, usually a period around 21 days. Tetracycline is incorporated into mineralizing bone and can be detected by its fluorescence.{{Cite web |title=Tetracycline labeling of bone |url=http://www.histosearch.com/histonet/Dec02/TetracyclinelabelingofbonA.html |archive-url=https://web.archive.org/web/20070312193518/http://www.histosearch.com/histonet/Dec02/TetracyclinelabelingofbonA.html |archive-date=12 March 2007 |vauthors=Mayton CA}} In "double tetracycline labeling", a second dose is given 11–14 days after the first dose, and the amount of bone formed during that interval can be calculated by measuring the distance between the two fluorescent labels.{{Cite web |date=8 January 2001 |title=Tetracycline Labeling |url=http://pathology2.jhu.edu/bonelab/4cycline.htm |archive-url=https://archive.today/20121215013608/http://pathology2.jhu.edu/bonelab/4cycline.htm |archive-date=15 December 2012 |website=The Johns Hopkins Medical Institutions.}}

Tetracycline is also used as a biomarker in wildlife to detect consumption of medicine- or vaccine-containing baits.{{Cite journal |vauthors=Olson CA, Mitchell KD, Werner PA |date=October 2000 |title=Bait ingestion by free-ranging raccoons and nontarget species in an oral rabies vaccine field trial in Florida |url=http://www.jwildlifedis.org/cgi/reprint/36/4/734 |url-status=dead |journal=Journal of Wildlife Diseases |volume=36 |issue=4 |pages=734–743 |doi=10.7589/0090-3558-36.4.734 |pmid=11085436 |s2cid=35102508 |archive-url=https://archive.today/20130415041932/http://www.jwildlifedis.org/cgi/reprint/36/4/734 |archive-date=15 April 2013}}

{{See also|Tooth bleaching}}

{{more med cn|section|date=November 2022}}

Use of tetracycline antibiotics can:{{Cite web |title=Tetracycline: MedlinePlus Drug Information |url=https://medlineplus.gov/druginfo/meds/a682098.html |url-status=live |archive-url=https://web.archive.org/web/20170510164238/https://medlineplus.gov/druginfo/meds/a682098.html |archive-date=10 May 2017 |access-date=19 May 2017 |website=medlineplus.gov |language=en}}

• Discolor permanent teeth (yellow-gray-brown), from prenatal period through childhood and adulthood.{{Cite journal |vauthors=Sánchez AR, Rogers RS, Sheridan PJ |date=October 2004 |title=Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity |journal=International Journal of Dermatology |volume=43 |issue=10 |pages=709–715 |doi=10.1111/j.1365-4632.2004.02108.x |pmid=15485524}} Children receiving long- or short-term therapy with a tetracycline or glycylcycline may develop permanent brown discoloration of the teeth.
• Be inactivated by calcium ions, so are not to be taken with milk, yogurt, and other dairy products
• Be inactivated by aluminium, iron, and zinc ions, not to be taken at the same time as indigestion remedies (some common antacids and over-the-counter heartburn medicines)
• Cause skin photosensitivity,{{Cite book |title=StatPearls |vauthors=Shutter MC, Akhondi H |date=2024 |publisher=StatPearls Publishing |location=Treasure Island (FL) |chapter=Tetracycline |pmid=31751095 |access-date=19 March 2024 |chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK549905/}} so exposure to the sun or intense light is not recommended
• Cause drug-induced lupus, and hepatitis
• Cause microvesicular fatty liver{{Citation |title=Demeclocycline |date=2012 |work=LiverTox: Clinical and Research Information on Drug-Induced Liver Injury |url=http://www.ncbi.nlm.nih.gov/books/NBK548848/ |access-date=20 March 2024 |place=Bethesda (MD) |publisher=National Institute of Diabetes and Digestive and Kidney Diseases |pmid=31644155}}
• Cause tinnitus{{Cite web |date=15 August 2022 |title=Tinnitus: Ringing in the ears and what to do about it |url=https://www.health.harvard.edu/newsletter_article/tinnitus-ringing-in-the-ears-and-what-to-do-about-it |website=Harvard Health Publishing Harvard Medical School}}{{Cite book |title=Antibiotics Manual : A Guide to Commonly Used Antimicrobials |vauthors=Schlossberg DL, Samuel R |publisher=John Wiley & Sons, Inc. |year=2017 |pages=367 |via=ProQuest Ebook Central}}
• Cause epigastric pain
• Interfere with methotrexate by displacing it from the various protein-binding sites
• Cause breathing complications, as well as anaphylactic shock, in some individuals
• Affect bone growth of the fetus, so should be avoided during pregnancy
• Fanconi syndrome may result from ingesting expired tetracyclines.

Caution should be exercised in long-term use when breastfeeding. Short-term use is safe; bioavailability in milk is low to nil.{{Cite book |title=Breastfeeding and Human Lactation |date=November 2010 |publisher=Jones & Bartlett Learning |veditors=Riordan J, Wambach K |page=179}} According to the U.S. Food and Drug Administration (FDA), cases of Stevens–Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme associated with doxycycline use have been reported, but a causative role has not been established.{{Cite web |date=27 August 2010 |title=FDA Adverse Events Reporting System |url=https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/ucm223734.htm |archive-url=https://web.archive.org/web/20110117121827/https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Surveillance/AdverseDrugEffects/ucm223734.htm |archive-date=17 January 2011 |access-date=14 January 2011 |website=Food and Drug Administration}}

Tetracycline inhibits protein synthesis by blocking the attachment of charged tRNA at the P site peptide chain. Tetracycline blocks the A-site so that a hydrogen bond is not formed between the amino acids. Tetracycline binds to the 30S and 50S subunit of microbial ribosomes. Thus, it prevents the formation of a peptide chain.{{Cite web |date=27 May 2011 |title=Mechanism of Action of Tetracyclines |url=http://pharmaxchange.info/press/2011/05/mechanism-of-action-of-tetracyclines/ |url-status=live |archive-url=https://web.archive.org/web/20120605235017/http://pharmaxchange.info/press/2011/05/mechanism-of-action-of-tetracyclines/ |archive-date=5 June 2012 |access-date=7 June 2012 |publisher=Pharmaxchange.info |vauthors=Mehta A}} The action is usually not inhibitory and irreversible even with the withdrawal of the drug. Mammalian cells are not vulnerable to the effect of Tetracycline as these cells contain no 30S ribosomal subunits so do not accumulate the drug.{{Cite web |title=Tetracycline, USP |url=https://toku-e.com/tetracycline-usp/ |access-date=2024-06-28 |website=TOKU-E |language=en}} This accounts for the relatively small off-site effect of tetracycline on human cells.{{Cite book |title=Todars Online Text Book of Bacteriology |vauthors=Todar K |date=2012 |chapter=Antimicrobial Agents in the Treatment of Infectious Disease. |access-date=27 August 2013 |chapter-url=http://textbookofbacteriology.net/antimicrobial_4.html |archive-url=https://web.archive.org/web/20131008103423/http://textbookofbacteriology.net/antimicrobial_4.html |archive-date=8 October 2013 |url-status=live}}

Bacteria usually acquire resistance to tetracycline from horizontal transfer of a gene that either encodes an efflux pump or a ribosomal protection protein. Efflux pumps actively eject tetracycline from the cell, preventing the build up of an inhibitory concentration of tetracycline in the cytoplasm.{{Cite journal |vauthors=Chopra I, Roberts M |date=June 2001 |title=Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance |journal=Microbiology and Molecular Biology Reviews |volume=65 |issue=2 |pages=232–60 ; second page, table of contents |doi=10.1128/MMBR.65.2.232-260.2001 |pmc=99026 |pmid=11381101}} Ribosomal protection proteins interact with the ribosome and dislodge tetracycline from the ribosome, allowing for translation to continue.{{Cite journal |vauthors=Connell SR, Tracz DM, Nierhaus KH, Taylor DE |date=December 2003 |title=Ribosomal protection proteins and their mechanism of tetracycline resistance |journal=Antimicrobial Agents and Chemotherapy |volume=47 |issue=12 |pages=3675–3681 |doi=10.1128/AAC.47.12.3675-3681.2003 |pmc=296194 |pmid=14638464}}

The tetracyclines, a large family of antibiotics, were discovered by Benjamin Minge Duggar in 1948 as natural products, and first prescribed in 1948.{{Cite web |title=Chemistry and chemical biology of tetracyclines |url=http://www.chm.bris.ac.uk/motm/tetracycline/tetracycline.htm |archive-url=https://web.archive.org/web/20070617003719/http://www.chm.bris.ac.uk/motm/tetracycline/tetracycline.htm |archive-date=17 June 2007 |access-date=20 June 2007 |vauthors=Klajn R}} {{better source needed|date=March 2017}} Benjamin Duggar, working under Yellapragada Subbarow at Lederle Laboratories, discovered the first tetracycline antibiotic, chlortetracycline (Aureomycin), in 1945.{{Cite journal |vauthors=Jukes TH |date=1985 |title=Some historical notes on chlortetracycline |journal=Reviews of Infectious Diseases |volume=7 |issue=5 |pages=702–707 |doi=10.1093/clinids/7.5.702 |jstor=4453725 |pmid=3903946}} The structure of Aureomycin was elucidated in 1952 and published in 1954 by the Pfizer-Woodward group.{{Cite journal |vauthors=Stephens CR, Conover LH, Pasternack R, Hochstein FA, Moreland WT, Regna PP, Pilgrim FJ, Brunings KJ, Woodward RB |date=July 1954 |title=The Structure of Aureomycin 1 |url=https://pubs.acs.org/doi/abs/10.1021/ja01642a064 |journal=Journal of the American Chemical Society |language=en |volume=76 |issue=13 |pages=3568–3575 |bibcode=1954JAChS..76.3568S |doi=10.1021/ja01642a064 |issn=0002-7863|url-access=subscription }} After the discovery of the structure, researchers at Pfizer began chemically modifying aureomycin by treating it with hydrogen in the presence of a palladized carbon catalyst. This chemical reaction replaced a chlorine moiety with a hydrogen, creating a compound named tetracycline via hydrogenolysis.{{Cite journal |vauthors=Conover LH, Moreland WT, English AR, Stephens CR, Pilgrim FJ |date=September 1953 |title=Terramycin. Xi. Tetracycline |url=https://pubs.acs.org/doi/abs/10.1021/ja01114a537 |journal=Journal of the American Chemical Society |language=en |volume=75 |issue=18 |pages=4622–4623 |bibcode=1953JAChS..75.4622C |doi=10.1021/ja01114a537 |issn=0002-7863|url-access=subscription }} Tetracycline displayed higher potency, better solubility, and more favorable pharmacology than the other antibiotics in its class, leading to its FDA approval in 1954. The new compound was one of the first commercially successful semi-synthetic antibiotics that was used, and laid the foundation for the development of Sancycline, Minocycline, and later the Glycylcyclines.{{Cite journal |vauthors=Nelson ML, Levy SB |date=December 2011 |title=The history of the tetracyclines |journal=Annals of the New York Academy of Sciences |volume=1241 |issue=1 |pages=17–32 |bibcode=2011NYASA1241...17N |doi=10.1111/j.1749-6632.2011.06354.x |pmid=22191524 |s2cid=34647314}}

Tetracycline has a high affinity for calcium and is incorporated into bones during the active mineralization of hydroxyapatite. When incorporated into bones, tetracycline can be identified using ultraviolet light.{{Cite journal |vauthors=Pautke C, Vogt S, Kreutzer K, Haczek C, Wexel G, Kolk A, Imhoff AB, Zitzelsberger H, Milz S, Tischer T |date=July 2010 |title=Characterization of eight different tetracyclines: advances in fluorescence bone labeling |journal=Journal of Anatomy |volume=217 |issue=1 |pages=76–82 |doi=10.1111/j.1469-7580.2010.01237.x |pmc=2913014 |pmid=20456523}}

There is evidence that early inhabitants of Northeastern Africa consumed tetracycline antibiotics. Nubian mummies from between 350 and 550 A.D. were found to exhibit patterns of fluorescence identical with that of modern tetracycline labelled bone.{{Cite journal |vauthors=Bassett EJ, Keith MS, Armelagos GJ, Martin DL, Villanueva AR |date=September 1980 |title=Tetracycline-labeled human bone from ancient Sudanese Nubia (A.D. 350) |journal=Science |volume=209 |issue=4464 |pages=1532–1534 |bibcode=1980Sci...209.1532B |doi=10.1126/science.7001623 |pmid=7001623}}

It is conjectured that the beer brewed by the Nubians was the source of the tetracycline found in these bones.{{Cite journal |vauthors=Armelagos G |date=2000 |title=Take Two Beers and Call Me in 1,600 Years: Use of Tetracycline by Nubians and Ancient Egyptians |journal=Natural History |volume=109 |issue=4 |pages=50–53}}

According to data from EvaluatePharma and published in the Boston Globe, in the USA the price of tetracycline rose from $0.06 per 250-mg pill in 2013 to $4.06 a pill in 2015.{{Cite web |date=6 November 2015 |title=As competition wanes, prices for generics skyrocket |url=https://www.bostonglobe.com/business/2015/11/06/generic-drug-price-increases-alarm-insurers-providers-and-consumers/H3iA9CSxAUylnCdGjLNKVN/story.html?event=event25 |url-status=live |archive-url=https://web.archive.org/web/20151119073901/http://www.bostonglobe.com/business/2015/11/06/generic-drug-price-increases-alarm-insurers-providers-and-consumers/H3iA9CSxAUylnCdGjLNKVN/story.html?event=event25 |archive-date=19 November 2015 |access-date=18 November 2015 |website=Boston Globe |vauthors=McCluskey PD}} The Globe described the "big price hikes of some generic drugs" as a "relatively new phenomenon" which has left most pharmacists "grappling" with large upswings" in the "costs of generics, with 'overnight' price changes sometimes exceeding 1,000%."

It is marketed under the brand names Sumycin, Tetracyn, and Panmycin, among others. Actisite is a thread-like fiber formulation used in dental applications.{{Cite journal |vauthors=Litch JM, Encarnacion M, Chen S, Leonard J, Burkoth TL |date=November 1996 |title=Use of the polymeric matrix as internal standard for quantitation of in vivo delivery of tetracycline HCl from Actisite tetracycline fiber during periodontal treatment |journal=Journal of Periodontal Research |volume=31 |issue=8 |pages=540–544 |doi=10.1111/j.1600-0765.1996.tb00518.x |pmid=8971652}}

It is also used to produce several semisynthetic derivatives, which together are known as the tetracycline antibiotics. The term "tetracycline" is also used to denote the four-ring system of this compound; "tetracyclines" are related substances that contain the same four-ring system.{{cn|date=March 2023}}

Due to the drug's association with fighting infections, it serves as the main "commodity" in the science fiction series Aftermath, with the search for tetracycline becoming a major preoccupation in later episodes.{{Cite web |title=Aftermath Episode Recap |url=https://www.syfy.com/aftermath/episodes/season/2016/episode/9/the-barbarous-king |url-status=dead |archive-url=https://web.archive.org/web/20171013003356/http://www.syfy.com/aftermath/episodes/season/2016/episode/9/the-barbarous-king |archive-date=13 October 2017 |access-date=15 April 2020 |website=SyFy Channel}}

Tetracycline is also represented in Bohemia Interactive's survival sandbox, DayZ. In the game, players may find the antibiotic to treat the common cold, influenza, cholera and infected wounds, but does not portray any side effects associated with tetracycline.{{cn|date=January 2025}}

In genetic engineering, tetracycline is used in transcriptional activation. It has been used as an engineered "control switch" in chronic myelogenous leukemia models in mice. Engineers were able to develop a retrovirus that induced a particular type of leukemia in mice, and could then "switch" the cancer on and off through tetracycline administration. This could be used to grow the cancer in mice and then halt it at a particular stage to allow for further experimentation or study.{{Cite journal |vauthors=Dugray A, Geay JF, Foudi A, Bonnet ML, Vainchenker W, Wendling F, Louache F, Turhan AG |date=October 2001 |title=Rapid generation of a tetracycline-inducible BCR-ABL defective retrovirus using a single autoregulatory retroviral cassette |journal=Leukemia |volume=15 |issue=10 |pages=1658–1662 |doi=10.1038/sj.leu.2402225 |pmid=11587226 |s2cid=40155100}}

A technique being developed for the control of the mosquito species Aedes aegypti (the infection vector for yellow fever, dengue fever, Zika fever, and several other diseases) uses a strain that is genetically modified to require tetracycline to develop beyond the larval stage. Modified males raised in a laboratory develop normally as they are supplied with this chemical and can be released into the wild. Their subsequent offspring inherit this trait, but find no tetracycline in their environments, so never develop into adults.{{Cite news |date=15 July 2012 |title=Can GM mosquitoes rid the world of a major killer? |url=https://www.theguardian.com/environment/2012/jul/15/gm-mosquitoes-dengue-fever-feature |url-status=live |archive-url=https://web.archive.org/web/20131205105805/http://www.theguardian.com/environment/2012/jul/15/gm-mosquitoes-dengue-fever-feature |archive-date=5 December 2013 |access-date=15 July 2012 |work=The Observer |vauthors=Urquhart C}}

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