From the Guidelines
Minocycline is a broad-spectrum antibiotic that effectively covers many gram-positive and gram-negative bacteria, including Staphylococcus aureus (including MRSA), Streptococcus species, and some anaerobes, making it a suitable option for the treatment of skin and soft-tissue infections, as recommended by the 2018 WSES/SIS-E consensus conference 1.
Key Points
- Minocycline has good activity against Propionibacterium acnes, making it useful for acne treatment.
- The typical dosage for adults is 100 mg twice daily or 200 mg once daily, with treatment duration varying by indication (7-14 days for most infections, but potentially months for acne or rosacea) 1.
- Minocycline penetrates tissues well, including the central nervous system, and has a long half-life allowing for convenient dosing.
- However, it has limited activity against Pseudomonas aeruginosa, Proteus, Serratia, and many Enterobacteriaceae.
- Resistance can develop through bacterial efflux pumps, ribosomal protection proteins, or enzymatic inactivation.
- Side effects include photosensitivity, vestibular issues (dizziness), and potential for tooth discoloration in children under 8 years old, so it should be avoided in young children, pregnant women, and those with severe liver disease.
Bacteria Coverage
- Minocycline is effective against:
- Staphylococcus aureus (including MRSA)
- Streptococcus species
- Neisseria gonorrhoeae
- Chlamydia
- Mycoplasma
- Some anaerobes
- Propionibacterium acnes
- Minocycline has limited activity against:
- Pseudomonas aeruginosa
- Proteus
- Serratia
- Many Enterobacteriaceae
Recommendations
- For oral antibiotic coverage of MRSA in patients with skin and soft-tissue infections, minocycline is a recommended option, along with linezolid, trimethoprim-sulfamethoxazole, and tedizolid 1.
- The duration of therapy should be individualized based on the patient's clinical response, but typically ranges from 7 to 14 days 1.
From the FDA Drug Label
MINOCIN® Intravenous is indicated in the treatment of the following infections due to susceptible isolates of the designated bacteria: Respiratory tract infections caused by Mycoplasma pneumoniae. Lymphogranuloma venereum caused by Chlamydia trachomatis. Psittacosis (Ornithosis) due to Chlamydophila psittaci. Trachoma caused by Chlamydia trachomatis, Inclusion conjunctivitis caused by Chlamydia trachomatis. Nongonococcal urethritis, endocervical, or rectal infections in adults caused by Ureaplasma urealyticum or Chlamydia trachomatis. Relapsing fever due to Borrelia recurrentis. Plague due to Yersinia pestis. Tularemia due to Francisella tularensis. Cholera caused by Vibrio cholerae. Campylobacter fetus infections caused by Campylobacter fetus. Brucellosis due to Brucella species (in conjunction with streptomycin). Bartonellosis due to Bartonella bacilliformis. Granuloma inguinale caused by Klebsiella granulomatis. Minocycline is indicated for the treatment of infections caused by the following Gram-negative bacteria when bacteriologic testing indicates appropriate susceptibility to the drug: Escherichia coli. Enterobacter aerogenes. Shigella species. Acinetobacter species. Respiratory tract infections caused by Haemophilus influenzae. Respiratory tract and urinary tract infections caused by Klebsiella species. MINOCIN® Intravenous is indicated for the treatment of infections caused by the following Gram-positive bacteria when bacteriologic testing indicates appropriate susceptibility to the drug: Upper respiratory tract infections caused by Streptococcus pneumoniae Skin and skin structure infections caused by Staphylococcus aureus
Minocycline has broad-spectrum antibacterial activity against both Gram-positive and Gram-negative bacteria, including:
- Gram-negative bacteria:
- Escherichia coli
- Enterobacter aerogenes
- Shigella species
- Acinetobacter species
- Haemophilus influenzae
- Klebsiella species
- Gram-positive bacteria:
- Streptococcus pneumoniae
- Staphylococcus aureus Minocycline is also effective against other microorganisms, including:
- Chlamydia trachomatis
- Mycoplasma pneumoniae
- Ureaplasma urealyticum
- Rickettsiae
- Treponema pallidum subspecies pallidum
- Treponema pallidum subspecies pertenue
- Borrelia recurrentis
- Yersinia pestis
- Francisella tularensis
- Vibrio cholerae
- Campylobacter fetus
- Brucella species
- Bartonella bacilliformis
- Klebsiella granulomatis 2
From the Research
Minocycline Bacteria Coverage
- Minocycline has been shown to be effective against a wide range of bacteria, including:
- Methicillin-sensitive and methicillin-resistant Staphylococcus aureus 3
- Gram-negative pathogens such as Acinetobacter species, Citrobacter species, Enterobacter species, Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Stenotrophomonas maltophilia 3
- Tetracycline-resistant staphylococci 4
- Minocycline has been used to treat various infections, including:
- The effectiveness of minocycline against gram-negative bacteria is notable, as these bacteria are often associated with high mortality rates in SSTIs 5, 6
- Minocycline may be used as an agent of last resort for treating multidrug-resistant gram-negative infections, due to its limited data availability 3