Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York, USA.
Pharmacotherapy. 2021 Nov;41(11):915-931. doi: 10.1002/phar.2625. Epub 2021 Oct 5.
Oral tetracyclines have been used in clinical practice for over 60 years. One of the most common indications for use of oral tetracyclines is for treatment of adult outpatients with skin and soft infections (SSTIs), including acute bacterial skin and skin structure infections (ABSSSIs). The 2014 Infectious Diseases Society of America (IDSA) skin and soft tissue guideline strongly recommends sulfamethoxazole/trimethoprim, clindamycin, and tetracyclines as oral treatment options for patients with purulent SSTIs, especially when methicillin-resistant Staphylococcus aureus is of clinical concern. Despite the long-standing use of tetracyclines, practice patterns indicate that they are often considered after other guideline-concordant oral options for the treatment of patients with SSTIs. Clinicians may therefore be less familiar with the clinical data associated with use of commercially available tetracycline agents for treatment of patients with SSTI. This review summarizes the literature on the use of oral tetracyclines (ie, doxycycline, minocycline, and omadacycline) for the treatment of adult patients with SSTIs. As part of this review, we describe their common mechanisms of resistance, susceptibility profiles against common SSTI pathogens, pharmacokinetics and pharmacodynamics, and comparative clinical data.
口服四环素类药物在临床实践中已经使用了 60 多年。使用口服四环素类药物的最常见适应症之一是治疗患有皮肤和软组织感染（SSTIs）的成年门诊患者，包括急性细菌性皮肤和皮肤结构感染（ABSSSIs）。2014 年美国传染病学会（IDSA）皮肤和软组织指南强烈推荐磺胺甲恶唑/甲氧苄啶、克林霉素和四环素类药物作为治疗脓性 SSTIs 的口服治疗选择，尤其是当临床关注耐甲氧西林金黄色葡萄球菌时。尽管四环素类药物的使用历史悠久，但实践模式表明，它们通常被认为是治疗 SSTIs 患者的其他符合指南的口服选择之后的选择。因此，临床医生可能对治疗 SSTI 患者时使用市售四环素类药物的临床数据不太熟悉。这篇综述总结了口服四环素类药物（即多西环素、米诺环素和奥马环素）治疗成人 SSTIs 的文献。作为这篇综述的一部分，我们描述了它们常见的耐药机制、对常见 SSTI 病原体的药敏谱、药代动力学和药效学以及比较临床数据。
