Comparative safety of tetracycline, minocycline, and doxycycline.
BACKGROUND
Because minocycline can cause serious adverse events including hypersensitivity syndrome reaction (HSR), serum sicknesslike reaction (SSLR), and drug-induced lupus, a follow-up study based on a retrospective review of our Drug Safety Clinic and the Health Protection Branch databases and a literature review was conducted to determine if similar rare events are associated with tetracycline and doxycycline. Cases of isolated single organ dysfunction (SOD) attributable to the use of these antibiotics also were identified.


METHODS
Nineteen cases of HSR due to minocycline, 2 due to tetracycline, and 1 due to doxycycline were identified. Eleven cases of SSLR due to minocycline, 3 due to tetracycline, and 2 due to doxycycline were identified. All 33 cases of drug-induced lupus were attributable to minocycline. Forty cases of SOD from minocycline, 37 cases from tetracycline, and 6 from doxycycline were detected. Hypersensitivity syndrome reaction, SSLR, and SOD occur on average within 4 weeks of therapy, whereas minocycline-induced lupus occurs on average 2 years after the initiation of therapy.


CONCLUSIONS
Early serious events occurring during the course of tetracycline antibiotic treatment include HSR, SSLR, and SOD. Drug-induced lupus, which occurs late in the course of therapy, is reported only with minocycline. We theorize that minocycline metabolism may account for the increased frequency of serious adverse events with this drug.
Shapiro
L E
LE
Department of Medicine, Sunnybrook Hospital, University of Toronto Medical School, Ontario, Canada.
Knowles
S R
SR
Shear
N H
NH
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000378:metabolism; D018771:Arthralgia / Q000139:chemically induced; D002170:Canada / Q000453:epidemiology; D019992:Databases as Topic; D004318:Doxycycline / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology; D004342:Drug Hypersensitivity / Q000209:etiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000139:chemically induced; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects* / Q000378:metabolism; D012189:Retrospective Studies; D012449:Safety; D012713:Serum Sickness / Q000139:chemically induced; D013577:Syndrome; D013752:Tetracycline / Q000009:adverse effects*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D013752:Tetracycline; D008911:Minocycline; D004318:Doxycycline