Pharmacotherapy Newsletter

Volume 1, Issue 9, 03/16/2009

Question

Part 1: How does the antibiotic tetracycline cause permanent staining of the teeth and who is at risk?

Answer

This is part 1 of a 3 part series.  The antibiotic tetracycline has been on the market for over 60 years and is used in the treatment of many gram negative and gram positive infections as well as chlamydial, mycoplasmal and rickettsial infections.  Unfortunately, tetracycline is associated with a number of adverse drug events, including permanent staining of the teeth.  The first case report of tooth discoloration in children occurred in 1956, with many others following.^1-4  As a result, tetracycline is not used during the second and third trimesters of pregnancy or in children up to 8 years of age.^2-4 Warning of this effect also extends to a number of derivatives of tetracycline including doxycycline (Adoxa Pak 1/150®, Doryx®, Monodox®) and minocycline (Minocin®, Dynacin®, Solodyn^TM) to name a few.  The development of minocycline was thought to address this side effect; unfortunately, the staining of teeth continues to occur.⁵  In fact, it began to occur in adults but through a different mechanism.  This will be discussed in part 2 of this series (next issue).