title: I.V. minocycline revisited for infections caused by multidrug-resistant organisms.
abstract: OBJECTIVE
  The evidence supporting the potential use of i.v. minocycline for serious infections caused by multidrug-resistant organisms (MDROs) is summarized.
  
  
  CONCLUSIONS
  Minocycline achieves good tissue penetration and excellent oral absorption. Minocycline achieves serum concentrations comparable to other tetracyclines, with peak serum concentrations ranging from 3 to 8.75 mg/L following i.v. administration of 200 mg. Minocycline retains antimicrobial activity against methicillin-sensitive and methicillin-resistant Staphylococcus aureus as well as many gram-negative pathogens, such as Acinetobacter species, Citrobacter species, Enterobacter species, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Stenotrophomonas maltophilia. Minocycline has been used to treat respiratory infections caused by Acinetobacter baumannii and bloodstream infections. The majority of these gram-negative infections were treated with combination therapy, with results similar to those seen with first-line agents. The ability to switch from parenteral to oral therapy and its favorable tissue penetration make minocycline an attractive option for severe respiratory or skin and skin structure infections. For A. baumannii infections, minocycline is the second most active agent in vitro and may be the only therapeutic option in certain cases. The overall clinical experience with minocycline supports its use to treat A. baumannii infections alone or in combination with other agents. Minocycline could be used to treat other MDRO gram-negative infections but only as an agent of last resort due to the limited data available.
  
  
  CONCLUSIONS
  The available pharmacokinetic and clinical data support the use of i.v. minocycline for the treatment of MDRO infections, including infections due to S. aureus coagulase-negative and gram-negative pathogens.
authors.affiliation: National Institutes of Health Clinical Center, Bethesda, MD.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Colton
authors.affiliation: Veterans Affairs Medical Center, Providence, RI.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: McConeghy
authors.affiliation: Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Schreckenberger
authors.affiliation: University of Illinois at Chicago, College of Pharmacy, Chicago, IL. danziger@uic.edu.
authors.forename: Larry H
authors.initials: LH
authors.lastname: Danziger
mesh_terms: D061605:Administration, Intravenous; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000378:metabolism; D008911:Minocycline / Q000008:administration & dosage* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D008911:Minocycline