What is the recommended dosing for tetracycline (Tetracycline) in the treatment of skin infections?

Tetracycline Dosing for Skin Infections

Standard Dosing Recommendation

For skin infections in adults, tetracycline should be dosed at 500 mg four times daily (QID) for 7-10 days, or alternatively 1 gram daily as 500 mg twice daily for less severe infections. 1

Adult Dosing Regimens

Standard Infections

• Usual dose: 500 mg four times daily OR 250 mg four times daily for typical skin infections 1
• Severe infections: 500 mg four times daily may be required for infections not responding to lower doses 1
• Duration: 7-10 days for most skin and soft tissue infections 1

Specific Infection Types

For certain skin-related infections where tetracycline class antibiotics are indicated:

• Mild tularemia with skin involvement: Tetracycline 500 mg four times daily 2
• Bubonic plague: Doxycycline 100 mg twice daily is preferred over tetracycline 2

Pediatric Dosing

• Children over 8 years: 10-20 mg/lb (25-50 mg/kg) body weight divided into four equal doses daily 1
• Children under 8 years: Tetracyclines are contraindicated due to permanent tooth discoloration risk 3

Critical Administration Guidelines

Absorption Considerations

• Administer with adequate fluids to reduce esophageal irritation and ulceration risk 1
• Avoid concurrent administration with antacids containing aluminum, calcium, or magnesium 1
• Separate from iron, zinc, or sodium bicarbonate preparations 1
• Food and dairy products impair absorption - take on empty stomach when possible 1

Renal Impairment

• Decrease total dosage by reducing individual doses and/or extending intervals between doses in patients with renal impairment 1

Clinical Context: Why Doxycycline is Preferred

While tetracycline dosing is established, doxycycline has largely replaced tetracycline as the preferred tetracycline-class antibiotic for skin infections due to superior pharmacologic properties 4:

• Doxycycline advantages: Twice-daily dosing (100 mg BID), well-absorbed with food, excellent tissue penetration, no renal dose adjustment needed 3, 4
• Tetracycline disadvantages: Four-times-daily dosing, food interactions, requires renal adjustment 1

Common Pitfalls

• Inadequate fluid intake with tablets increases esophageal ulceration risk 1
• Taking with food or dairy significantly reduces absorption and therapeutic efficacy 1
• Drug interactions with common supplements (calcium, iron, antacids) are frequently overlooked 1
• Premature discontinuation before completing 7-10 day course leads to treatment failure 3

When Tetracycline is NOT Appropriate

• MRSA infections: Tetracycline has variable activity; doxycycline, clindamycin, or TMP-SMX are preferred 3, 5
• Streptococcal infections: When used, continue for full 10 days 1
• Pregnancy: Generally contraindicated except for life-threatening infections 3