Which antibiotics can cause photosensitivity as an adverse reaction?

From the Guidelines

Antibiotics that can cause photosensitivity as a reaction include tetracyclines, such as doxycycline and minocycline, as well as sulfonamides, like trimethoprim/sulfamethoxazole, and these can lead to severe skin reactions, including exaggerated sunburn, rash, or inflammation, when exposed to UV light 1. When considering the potential for photosensitivity, it's crucial to weigh the benefits of antibiotic treatment against the risks, particularly for patients who will be exposed to sunlight during their treatment course.

• The tetracycline class of antibiotics, including doxycycline and minocycline, is known to cause photosensitivity, with doxycycline being more photosensitizing than minocycline 1.
• Sulfonamides, such as trimethoprim/sulfamethoxazole, can also cause photosensitivity, along with other adverse events like gastrointestinal upset and drug eruptions 1.
• Macrolides and penicillins are less commonly associated with photosensitivity but can cause other adverse events like gastrointestinal disturbances and hypersensitivity reactions 1. To manage the risk of photosensitivity, patients taking these antibiotics should use broad-spectrum sunscreen (SPF 30+), wear protective clothing, avoid peak sun hours (10am-4pm), and stay in the shade when possible.
• Photosensitivity reactions typically resolve within days to weeks after stopping the medication, but severe reactions may require immediate medical attention and potentially switching to a different antibiotic 1. Given the potential for severe skin reactions, it's essential to closely monitor patients taking photosensitizing antibiotics and provide them with clear guidance on sun protection and the signs of photosensitivity reactions.

From the FDA Drug Label

Photosensitivity/Phototoxicity: Patients should be advised that photosensitivity/phototoxicity has been reported in patients receiving fluoroquinolone antibiotics. Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines. Moderate to severe photosensitivity/phototoxicity reactions, the latter of which may manifest as exaggerated sunburn reactions (e.g., burning, erythema, exudation, vesicles, blistering, edema) involving areas exposed to light (typically the face, “V” area of the neck, extensor surfaces of the forearms, dorsa of the hands), can be associated with the use of quinolones after sun or UV light exposure.

The antibiotics that can cause photosensitivity as a reaction are:

• Levofloxacin 2
• Ciprofloxacin 3
• Minocycline 4

These antibiotics may cause photosensitivity or phototoxicity, and patients should minimize or avoid exposure to natural or artificial sunlight while taking these drugs.

From the Research

Antibiotics that can Cause Photosensitivity

• Tetracyclines, a group of broad-spectrum antibiotics, can cause photosensitivity reactions, which are divided into phototoxic or photoallergic reactions 5
• Specific tetracyclines that can cause photosensitivity include:
  • Doxycycline 5, 6
  • Minocycline 5, 7
  • Tetracycline 5
  • Lymecycline 5
  • Sarecycline 5
  • Demethylchlortetracycline 5
  • Chlortetracycline 5
  • Metacycline 5

Clinical Manifestations of Photosensitivity

• Clinical symptoms of photosensitivity caused by doxycycline can vary from light sunburn-like sensation (burning, erythema) to large-area photodermatitis 6
• Onycholysis is also possible as a clinical manifestation of photosensitivity caused by doxycycline 6

Prevention of Photosensitivity

• Travelers to tropical countries taking doxycycline for malaria prophylaxis need thorough medical counseling to avoid possibly severe phototoxic reactions 6
• UV-protective products that cover the UVA1 spectrum (340-400 nm) should be used to prevent photosensitivity reactions 6