COMPARATIVE SAFETY OF TETRACYCLINE, MINOCYCLINE, AND DOXYCYCLINE

Background: Because minocycline can cause serious adverse events inclu ding hypersensitivity syndrome reaction (HSR), serum sicknesslike reac tion (SSLR), and drug-induced lupus, a follow-up study based on a retr ospective review of our Drug Safety Clinic and the Health Protection B ranch 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 u se of these antibiotics also were identified. Observations: Nineteen c ases of HSR due to minocycline, 2 due to tetracycline, and 1 due to do xycycline 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 ca ses of SOD from minocycline, 37 cases from tetracycline, and 6 from do xycycline were detected. Hypersensitivity syndrome reaction, SSLR, and SOD occur on average within 4 weeks of therapy, whereas minocycline-i nduced lupus occurs on average 2 years after the initiation of therapy . Conclusions: Early serious events occurring during the course of tet racycline antibiotic treatment include HSR, SSLR, and SOD. Drug-induce d 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.