Abstract
Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.
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No funding or sponsorship was received for this study or publication of this article.
Author Contributions
Study concept and design: Alexis L. Angelette, Lauren L. Rando, Reena D. Wadhwa, Ashley A. Barras, Blake M. Delacroix, Norris C. Talbot, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Adam M. Kaye and Alan D. Kaye. Analysis and interpretation of data: Alexis L. Angelette, Lauren L. Rando, Reena D. Wadhwa, Ashley A. Barras, Blake M. Delacroix, Norris C. Talbot, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Adam M. Kaye and Alan D. Kaye. Drafting of the manuscript: Alexis L. Angelette, Lauren L. Rando, Reena D. Wadhwa, Ashley A. Barras, Blake M. Delacroix, Norris C. Talbot, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Adam M. Kaye and Alan D. Kaye. Critical revision of the manuscript for important intellectual content: Alexis L. Angelette, Lauren L. Rando, Reena D. Wadhwa, Ashley A. Barras, Blake M. Delacroix, Norris C. Talbot, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Adam M. Kaye and Alan D. Kaye. Statistical analysis: Alexis L. Angelette, Lauren L. Rando, Reena D. Wadhwa, Ashley A. Barras, Blake M. Delacroix, Norris C. Talbot, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Adam M. Kaye and Alan D. Kaye.
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Alexis L. Angelette has nothing to disclose. Lauren L. Rando has nothing to disclose. Reena D. Wadhwa has nothing to disclose. Reena D. Wadhwa has nothing to disclose. Blake M. Delacroix has nothing to disclose. Norris C. Talbot has nothing to disclose. Shahab Ahmadzadeh has nothing to disclose. Sahar Shekoohi has nothing to disclose. Elyse M. Cornett has nothing to disclose. Adam M. Kaye has nothing to disclose. Alan D. Kaye has nothing to disclose.
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This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
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Angelette, A.L., Rando, L.L., Wadhwa, R.D. et al. Tetracycline-, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation. Adv Ther 40, 1366–1378 (2023). https://doi.org/10.1007/s12325-023-02435-y
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DOI: https://doi.org/10.1007/s12325-023-02435-y