Minocycline Indications and Dosages
Minocycline is indicated for non-tuberculous mycobacterial pulmonary disease (NTM-PD), moderate to severe acne vulgaris, methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections, and infections caused by Acinetobacter baumannii resistant to carbapenems. 1, 2
Indications
Non-Tuberculous Mycobacterial Pulmonary Disease (NTM-PD)
- Recommended for treatment of NTM pulmonary disease, though not licensed for this indication in the UK 1
- Used as part of multi-drug regimens for NTM infections 1
Acne Vulgaris
- Indicated for moderate to severe inflammatory acne 1, 3
- Recommended as a second-line agent after doxycycline due to safety concerns 1, 4
- Should be limited to 3-4 months of use to minimize bacterial resistance 3
Skin and Soft Tissue Infections
- Effective for MRSA skin and soft tissue infections 1
- Alternative to vancomycin or linezolid for patients who cannot tolerate first-line agents 1
Other Indications
- Treatment of blepharitis 2
- Treatment of infections caused by carbapenem-resistant Acinetobacter baumannii 2
Dosage Recommendations
For NTM-PD
For Acne Vulgaris
- Adults: 50 mg 1-3 times daily 3
- Children ≥8 years: Initial dose 4 mg/kg followed by 2 mg/kg every 12 hours 3
- Treatment duration typically limited to 3-4 months 3
For MRSA Skin and Soft Tissue Infections
For Intravenous Administration
- Initial dose of 200 mg, then 100 mg every 12 hours 5
- Should not exceed 400 mg in 24 hours 5
- For pediatric patients >8 years: Initial dose of 4 mg/kg, then 2 mg/kg every 12 hours 5
Contraindications
- Children under 8 years of age due to risk of permanent tooth discoloration and enamel hypoplasia 1, 2, 3
- Pregnancy and breastfeeding 1, 3
- Hypersensitivity to minocycline or other tetracyclines 1, 2
- Systemic lupus erythematosus (risk of exacerbation) 1
Precautions and Monitoring
- Monitor for vestibular side effects (dizziness, vertigo) 6, 4
- Monitor liver function, especially with prolonged use 1, 4
- Complete blood count (CBC) weekly for first 2 months, then monthly if stable 1
- Use with caution in renal impairment; no dose adjustment required but monitor for adverse effects 1, 2
- Use with caution in hepatic impairment 1, 2
- Avoid direct exposure to sunlight or UV radiation due to photosensitivity risk 1
- Monitor for skin hyperpigmentation with long-term use 6, 4
Adverse Effects
Common
- Gastrointestinal: nausea, vomiting, diarrhea, dysphagia 1, 2
- Dermatological: photosensitivity, rash 1, 2
- Neurological: dizziness, headache 1, 2, 7
Serious
- Autoimmune disorders: drug-induced lupus, autoimmune hepatitis 1, 4
- Hypersensitivity reactions including DRESS syndrome 3, 4
- Benign intracranial hypertension 1, 6
- Skin hyperpigmentation with long-term use (>70g cumulative dose) 6
- Hepatotoxicity: hepatitis, jaundice, hepatic failure 1
- Hematological: hemolytic anemia, thrombocytopenia, neutropenia 1
Clinical Considerations
- Minocycline is not more effective than other tetracyclines for acne but has better pharmacokinetics 4
- For acne treatment, clinical improvement typically begins within 1-2 weeks 3
- For tetracycline-recalcitrant acne, low-dose minocycline (50 mg twice daily) may be effective 8
- Resistance to minocycline can develop with prolonged use 4
- Take with plenty of water during meals while sitting or standing to prevent esophageal irritation 1
- Avoid consumption of large amounts of tyramine-rich foods 1
Comparative Efficacy and Safety
- Doxycycline is generally preferred over minocycline for acne due to better safety profile 1, 4
- Minocycline has more severe adverse effects than doxycycline but lacks phototoxicity 4
- Sarecycline is a newer, narrow-spectrum tetracycline with fewer side effects but higher cost 1
- No evidence that minocycline is superior to other commonly used acne treatments 9