Use of Oral Tetracyclines in the Treatment of Adult Patients with Community-Acquired Bacterial Pneumonia: A Literature Review on the Often-Overlooked Antibiotic Class.

Monique R. Bidell,Manjunath (Amit) P. Pai,Thomas P. Lodise

doi:10.3390/antibiotics9120905

Abstract

Oral tetracyclines have been used in clinical practice for over 60 years. Overall, one of the most common indications for use of oral tetracyclines is for treatment of adult outpatients with lower respiratory tract infections, including community-acquired pneumonia (CAP). Despite the longstanding use of oral tetracyclines, practice patterns indicate that they are often considered after other guideline-concordant oral CAP treatment options (namely macrolides, fluoroquinolones, and β-lactams). However, there are growing resistance or safety concerns with the available oral agents listed for outpatients with CAP in the updated American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) CAP guidelines, especially among patients with comorbidities or notable risk factors for resistant pathogens. Given the need for alternative oral agents to macrolides, fluoroquinolones, and beta-lactams for adult outpatients with CAP, this review summarizes the literature on the use of oral tetracyclines (i.e., doxycycline, minocycline, and omadacycline) for this indication. As part of this review, we described their mechanism of action, common mechanisms of resistance, susceptibility profiles against common CAP pathogens, pharmacokinetics, pharmacodynamics, clinical data, and safety. The intent of the review is to highlight the important considerations when deciding between doxycycline, minocycline, and omadacycline for an adult outpatient with CAP in situations in which use of an oral tetracycline is warranted.

Highlights

Oral tetracyclines have been used in clinical practice for over 60 years [1]
Given the need for alternative oral agents to macrolides, fluoroquinolones, and beta-lactams for adult outpatients with community-acquired pneumonia (CAP), this review summarizes the literature on the use of oral tetracyclines for this indication
Studies were reviewed for inclusion based on title and specific interest was placed on titles that included specific tetracycline agents, studies that mentioned tetracyclines for CAP, or studies that compared resistance among CABP treatments for the most common bacterial pathogens (i.e., S. pneumoniae, H. influenzae, M. catarrhalis, C. pneumoniae, M. pneumoniae, Legionella spp.)

Summary

Introduction

Oral tetracyclines have been used in clinical practice for over 60 years [1]. These agents are characterized by their relatively broad activity against Gram-positive, Gram-negative, and atypical pathogens as well as a generally favorable safety profile [2,3,4,5,6]. One of the most common indications for use of an oral tetracycline-like antibiotic is for treatment of adult patients with community-acquired pneumonia (CAP). The updated American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) CAP guidelines recommend use of doxycycline monotherapy as an option for outpatients without comorbidities or notable risk factors for resistant pathogens [7]. Omadacycline, a derivative of minocycline and first-in-class aminomethylcycline antibiotic, was recently approved for the treatment of adult patients with community-acquired bacterial

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