title: Doxycycline and Tigecycline: Two Friendly Drugs with a Low Association with Clostridium Difficile Infection.
abstract: Clostridium difficile infection (CDI) is known to be associated with prior exposure to many classes of antibiotics. Standard therapy for CDI (i.e., metronidazole and vancomycin) is associated with high recurrence rates. Although tetracycline derivatives such as tetracycline, doxycycline or tigecycline are not the standard therapeutic choices for CDI, they may serve as an alternative or a component of combination therapy. Previous tetracycline or doxycycline usage had been shown to have less association with CDI development. Tigecycline, a broad-spectrum glycylcycline with potency against many gram-positive or gram-negative pathogens, had been successfully used to treat severe or refractory CDI. The in vitro susceptibility of C. difficile clinical isolates to tigecycline in many studies showed low minimal inhibitory concentrations. Tigecycline can suppress in vitro toxin production in both historical and hypervirulent C. difficile strains and reduce spore production in a dose-dependent manner. Tetracycline compounds such as doxycycline, minocycline, and tigecycline possess anti-inflammatory properties that are independent of their antibiotic activity and may contribute to their therapeutic effect for CDI. Although clinical data are limited, doxycycline is less likely to induce CDI, and tigecycline can be considered one of the therapeutic choices for severe or refractory CDI.
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan 70043, Taiwan. yuebin16@yahoo.com.tw.|Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 70403, Taiwan. yuebin16@yahoo.com.tw.|Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan 70403, Taiwan. yuebin16@yahoo.com.tw.
authors.forename: Yuan-Pin
authors.initials: YP
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 70403, Taiwan. jclee.eric@msa.hinet.net.
authors.forename: Jen-Chieh
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan 70043, Taiwan. angeltearsjuju@yahoo.com.tw.|Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 70403, Taiwan. angeltearsjuju@yahoo.com.tw.|Graduate Institute of Clinical Medicine, National Health Research Institutes, Tainan 70403, Taiwan. angeltearsjuju@yahoo.com.tw.
authors.forename: Hsiao-Ju
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan 70043, Taiwan. peijtsai@mail.ncku.edu.com.|Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, Tainan 70102, Taiwan. peijtsai@mail.ncku.edu.com.
authors.forename: Hsiao-Chieh
authors.initials: HC
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, E-da Hospital, Kaohsiung 82445, Taiwan. wuyihui@gmail.com.
authors.forename: Yi-Hui
authors.initials: YH
authors.lastname: Wu
authors.affiliation: Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Medical College, Tainan 70102, Taiwan. peijtsai@mail.ncku.edu.com.|Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan 70102, Taiwan. peijtsai@mail.ncku.edu.com.
authors.forename: Pei-Jane
authors.initials: PJ
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan 70403, Taiwan. winston3415@gmail.com.|Department of Medicine, National Cheng Kung University, Medical College, Tainan 70102, Taiwan. winston3415@gmail.com.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
keywords: Clostridium difficile; doxycycline; tigecycline