minocycline and Skin-Diseases--Infectious

Skin and soft tissue infections (SSTIs) are a common cause of hospital admission among elderly patients, and traditionally have been divided into complicated and uncomplicated SSTIs. In 2010, the FDA provided a new classification of these infections, and a new category of disease, named acute bacterial skin and skin structure infections (ABSSSIs), has been proposed as an independent clinical entity. ABSSSIs include three entities: cellulitis and erysipelas, wound infections, and major cutaneous abscesses This paper revises the epidemiology of SSTIs and ABSSSIs with regard to etiologies, diagnostic techniques, and clinical presentation in the hospital settings. Particular attention is owed to frail patients with multiple comorbidities and underlying significant disease states, hospitalized on internal medicine wards or residing in nursing homes, who appear to be at increased risk of infection due to multi-drug resistant pathogens and treatment failures. Management of ABSSSIs and SSTIs, including evaluation of the hemodynamic state, surgical intervention and treatment with appropriate antibiotic therapy are extensively discussed.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Carbapenems; Ceftaroline; Cephalosporins; Daptomycin; Female; Fluoroquinolones; Glycopeptides; Hospitalization; Humans; Iatrogenic Disease; Internal Medicine; Linezolid; Lipoglycopeptides; Male; Minocycline; Oxazolidinones; Skin Diseases, Infectious; Soft Tissue Infections; Teicoplanin; Tigecycline; Vancomycin

In the present review, the authors focus on skin and soft tissue infections (SSTIs), a set of commonly observed pathologies which can present different features in terms of site and localization, clinical characteristics, and the aetiological agent responsible; their severity is related to the depth of the affected sites. After a brief introduction to the diverse classification criteria which are currently adopted by various authors, the aetiology and role of the most frequently occurring pathogen, Staphylococcus aureus, often methicillin-resistant is discussed, as well as the possible therapeutic options. We first present the internationally recommended guidelines, and stress that SSTI management has to conform to different criteria, in accordance with the different clinical settings: mild infections require simple and cost-saving treatments while severe infections make timely and aggressive treatments mandatory. The review then reports the recent data concerning the efficacy of new antimicrobials for treating SSTIs. In particular, results observed with linezolid, tigecycline, and daptomycin are discussed.

Topics: Acetamides; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Daptomycin; Humans; Linezolid; Methicillin Resistance; Middle Aged; Minocycline; Oxazolidinones; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Skin Diseases, Infectious; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Tigecycline; Time Factors; Treatment Outcome

Topics: Adult; Aged; Bacterial Infections; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Approval; Female; Humans; Infusions, Intravenous; Middle Aged; Minocycline; Randomized Controlled Trials as Topic; Sensitivity and Specificity; Skin Diseases, Infectious; Tigecycline; Treatment Outcome; United States; United States Food and Drug Administration

Tetracycline and its derivatives are frequently used in the treatment of acne, soft tissue bacterial infections, Lyme disease (borreliosis), chlamydial-infections, and respiratory tract infections. Several pharmacologic and microbiological properties of these antibiotics make them particularly suitable for such uses. First-generation tetracyclines have long been in use; however, the second-generation tetracyclines minocycline, doxycycline hyclate, and doxycycline monohydrate have also become widely prescribed, and can offer advantages to the dermatologist over tetracycline. This paper reviews the important pharmacologic and microbiological characteristics of these three commonly used second-generation tetracyclines, and their clinical applications in dermatology.

Topics: Adult; Age Factors; Aged; Doxycycline; Humans; Minocycline; Skin Diseases, Infectious; Tetracyclines

Complicated skin and skin structure infections (cSSSIs) frequently result in hospitalization with significant morbidity and mortality.. In this phase 3b/4 parallel, randomized, open-label, comparative study, 531 subjects with cSSSI received tigecycline (100 mg initial dose, then 50 mg intravenously every 12 hrs) or ampicillin-sulbactam 1.5-3 g IV every 6 hrs or amoxicillin-clavulanate 1.2 g IV every 6-8 hrs. Vancomycin could be added at the discretion of the investigator to the comparator arm if methicillin-resistant Staphylococcus aureus (MRSA) was confirmed or suspected within 72 hrs of enrollment. The primary endpoint was clinical response in the clinically evaluable (CE) population at the test-of-cure (TOC) visit. Microbiologic response and safety were also assessed. The modified intent-to-treat (mITT) population comprised 531 subjects (tigecycline, n = 268; comparator, n = 263) and 405 were clinically evaluable (tigecycline, n = 209; comparator, n = 196).. In the CE population, 162/209 (77.5%) tigecycline-treated subjects and 152/196 (77.6%) comparator-treated subjects were clinically cured (difference 0.0; 95% confidence interval [CI]: -8.7, 8.6). The eradication rates at the subject level for the microbiologically evaluable (ME) population were 79.2% in the tigecycline treatment group and 76.8% in the comparator treatment group (difference 2.4; 95% CI: -9.6, 14.4) at the TOC assessment. Nausea, vomiting, and diarrhea rates were higher in the tigecycline group.. Tigecycline was generally safe and effective in the treatment of cSSSIs.. ClinicalTrials.gov NCT00368537.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Female; Humans; Male; Middle Aged; Minocycline; Skin Diseases, Bacterial; Skin Diseases, Infectious; Sulbactam; Tigecycline

Tigecycline, a first-in-class expanded glycylcycline antimicrobial agent, has demonstrated efficacy in the treatment of complicated skin and skin structure infections (cSSSI) and complicated intra-abdominal (cIAI) infections. A population pharmacokinetic (PK) model for tigecycline was developed for patients with cSSSI or cIAI enrolled in two phase 2 clinical trials, and the influence of selected demographic factors and clinical laboratory measures was investigated. Tigecycline was administered as an intravenous loading dose followed by a 0.5- or 1-h infusion every 12 h for up to 14 days. Blood samples were collected the day before or the day of hospital discharge for the determination of serum tigecycline concentrations. Patient covariates were evaluated using stepwise forward (alpha = 0.05) and backward (alpha = 0.001) procedures. The predictive performance of the model was assessed separately using pooled data from either two phase 3 studies for patients with cSSSI or two phase 3 studies for patients with cIAI. A two-compartment model with zero-order input and first-order elimination adequately described the steady-state tigecycline concentration-time data. Tigecycline clearance was shown to increase with increasing weight, increasing creatinine clearance, and male gender (P < 0.001). The final model provided a relatively unbiased fit to each data set. Individual predicted values of the area under the concentration-time curve from 0 to 12 h (AUC(0-12)) were generally unbiased (median prediction error, -1.60% to -3.78%) and were similarly precise (median absolute prediction error, <4%) when compared across data sets. The population PK model provided the basis to obtain individual estimates of steady-state AUC(0-12) in later exposure-response analyses of tigecycline safety and efficacy in patients with cSSSI or cIAI.

Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Area Under Curve; Bacterial Infections; Female; Humans; Male; Middle Aged; Minocycline; Models, Statistical; Population; Skin Diseases, Infectious; Tigecycline

Topics: Child; Dosage Forms; Humans; Minocycline; Otorhinolaryngologic Diseases; Respiratory Tract Infections; Skin Diseases, Infectious; Tablets; Tetracyclines

The antistaphylococcal properties of orally administered minocycline and penicillin-V were compared for one hundred and fifteen patients receiving minocycline and one hundred and twenty-eight receiving penicillin-V for various types of cutaneous infections. The majority of bacterial isolates were staphylococcal organisms. Of these 82 percent showed initial in vitro sensitivity to minocycline while only 20 percent did to penicillin-V. The percentage of clinical cures was higher with minocycline (74 percent) than with penicillin-V (54 percent), however, most patients, in both groups, showed clinical improvement. The rate of clinical improvement appeared to be significantly faster with minocycline. There was a higher percentage of adverse, chiefly vestibular, effects in the minocycline group (16 percent vs 7 percent). The study clearly demonstrates the superior antistaphylococcal properties of minocycline as compared with penicillin-V.

Topics: Adolescent; Adult; Aged; Child; Clinical Trials as Topic; Female; Humans; Male; Middle Aged; Minocycline; Penicillin Resistance; Penicillin V; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus; Tetracyclines

Topics: Administration, Oral; Bacterial Infections; Clinical Trials as Topic; Female; Humans; Injections, Intravenous; Male; Minocycline; Respiratory Tract Infections; Skin Diseases, Infectious; Tetracycline; Urinary Tract Infections

Infections caused by Acinetobacter baumannii are difficult to cure due to the acquisition of resistance by these bacteria and lead to an increase in the general costs of hospitalization. The aim of this study was to determine tigecycline susceptibility of Acinetobacter baumannii strains isolated from intensive care unit and non-intensive care unit patients with skin and soft tissue infections.. MICs were tested by Etest among 70 Acinetobacter baumannii isolates.. The MIC range was from 0.5 to 8.0 mg L⁻¹. For ESBL-producing Acinetobacter baumannii, as well as for strains without carbapenemases, the highest MIC to tigecycline value was 8.0 mg L⁻¹. For AmpC-producing Acinetobacter baumannii, the highest MIC to tigecycline value was 6.0 mg L⁻¹ and, for MBL-producing strains, 2.0 mg L⁻¹.. The majority of Acinetobacter baumannii strains isolated from ICU and non-ICU patients demonstrated high values of MIC range, MIC50 and MIC90 to tigecycline.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Drug Resistance, Multiple, Bacterial; Humans; Intensive Care Units; Microbial Sensitivity Tests; Minocycline; Skin Diseases, Infectious; Soft Tissue Infections; Tigecycline

Tigecycline is a novel 9-t-butylglycylamido derivative of minocycline that has demonstrated activity against a variety of bacterial pathogens, including resistant isolates, during preclinical studies. In vitro activities of tigecycline and comparators were tested against 11,859 recent (2000 and 2002) bacterial strains recovered from patients in 29 countries with community-acquired respiratory tract disease (3,317 gram-positive and -negative strains) and skin and soft tissue infections (8,542 gram-positive strains). All oxacillin-susceptible and -resistant Staphylococcus aureus (5,077 strains; tigecycline MIC(90), 0.5 microg/mL) and coagulase-negative staphylococci (1,432 strains; MIC(90), 0.5 microg/mL), penicillin-susceptible and -resistant Streptococcus pneumoniae (1,585 strains; MIC(90), < or =0.25 microg/mL), viridans group streptococci (212 strains; MIC(90), < or =0.25-0.5 microg/mL), vancomycin-susceptible and -resistant enterococci (1,416 strains; MIC(90), 0.25-0.5 microg/mL), beta-haemolytic streptococci (405 strains; MIC(90), < or =0.25 microg/mL), beta-lactamase positive and negative Haemophilus influenzae (1,220 strains; MIC(90), 1 microg/mL), Moraxella catarrhalis (495 strains; MIC(90), 0.25 microg/mL), and Neisseria meningitidis (17 strains; MIC(90), < or =0.12 microg/mL) were inhibited by 2 microg/mL or less of tigecycline. Whereas potency of tetracycline and doxycycline markedly dropped in various resistant organism subsets, tigecycline was unaffected with an overall MIC(90) of 0.5 microg/mL. These findings confirm that tigecycline maintains a truly broad spectrum like the tetracycline class while enhancing potency. It also incorporates stability to the commonly occurring tetracycline resistance mechanisms, making it an attractive candidate for continued clinical development against pathogens causing serious community-acquired respiratory tract infections, as well as cutaneous infections.

Topics: Anti-Bacterial Agents; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Female; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Male; Minocycline; Respiratory Tract Infections; Sensitivity and Specificity; Skin Diseases, Infectious; Tigecycline; United States

GAR-936 is a new semisynthetic glycylcycline with a broad antibacterial spectrum, including tetracycline-resistant strains. The in vitro activities of GAR-936, minocycline, doxycycline, tetracycline, moxifloxacin, penicillin G, and erythromycin were determined by agar dilution methods against 268 aerobic and 148 anaerobic strains of bacteria (including Pasteurella, Eikenella, Moraxella, Bergeyella, Neisseria, EF-4, Bacteroides, Prevotella, Porphyromonas, Fusobacterium, Staphylococcus, Streptococcus, Enterococcus, Corynebacterium, Propionibacterium, Peptostreptococcus, and Actinomyces) isolated from infected human and animal bite wounds in humans, including strains resistant to commonly used antimicrobials. GAR-936 was very active, with an MIC at which 90% of the strains are inhibited (MIC(90)) of < or =0.25 microg/ml, against all aerobic gram-positive and -negative strains, including tetracycline-resistant strains of Enterococcus, Streptococcus, and coagulase-negative staphylococci, except for Eikenella corrodens (MIC(90), < or =4 microg/ml). GAR-936 was also very active against all anaerobic species, including tetracycline-, doxycycline-, and minocycline-resistant strains of Prevotella spp., Porphyromonas spp., Bacteroides tectum, and Peptostreptococcus spp., with an MIC(90) of < or =0.25 microg/ml. Erythromycin- and moxifloxacin-resistant fusobacteria were susceptible to GAR-936, with an MIC(90) of 0.06 microg/ml.

Topics: Animals; Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Bites and Stings; Humans; Microbial Sensitivity Tests; Minocycline; Skin Diseases, Infectious; Soft Tissue Infections; Tigecycline

Combination effects of fosfomycin (FOM) and other oral antimicrobial agents were studied against methicillin-resistant Staphylococcus aureus (MRSA) (methicillin: minimal inhibitory concentration (MIC) greater than or equal to 12.5 micrograms/ml) isolated from skin and skin structure infections. The fractional inhibitory concentration (FIC) index equal to or less than 0.5 was seen in 63.0% of 27 MRSA strains for FOM and minocycline combination, in 44.4% for FOM and cefatrizine, in 44.4% for FOM and cefaclor, in 40.7% for FOM and cefalexin, in 37.0% for FOM and doxycycline, in 29.6% for FOM and erythromycin, in 22.2% for FOM and rokitamycin, in 18.5% for FOM and ofloxacin, in 14.8% for FOM and sultamicillin, in 11.1% for FOM and clavulanic acid/amoxicillin. The combination effects of FOM and minocyclin, or FOM and cephalosporins were higher than other combinations with FOM. Combination of FOM with other antibiotics could be a useful way to treat MRSA skin and skin structure infections.

Topics: Administration, Oral; Cephalosporins; Doxycycline; Drug Therapy, Combination; Erythromycin; Fosfomycin; Humans; Methicillin Resistance; Minocycline; Skin; Skin Diseases, Infectious; Staphylococcus aureus

A patient with systemic lupus erythematosus had a protracted skin infection with Mycobacterium marinum after a puffer fish sting. Disseminated cutaneous and synovial disease was associated with clinically active systemic lupus erythematosus two years after the initial infection. The infection was poorly responsive to multiple antituberculous regimens. Hematogenous spread of infection was the likely route of dissemination.

Topics: Adult; Animals; Cellulitis; Female; Fish Venoms; Fishes, Poisonous; Humans; Lupus Erythematosus, Systemic; Minocycline; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Synovitis; Tendinopathy; Wrist

An acute localized, purulent skin lesion developed on the right knee of an 8-year-old girl and was subsequently diagnosed as a primary cutaneous Nocardia brasiliensis infection. It was soon accompanied by intense lymphangitis and regional adenopathy. The patient had a history of a minor abrasion contaminated by soil at the site of infection 8 days before the infection became evident. The infection was successfully treated with a combination of minocycline and dapsone.

Topics: Acute Disease; Child; Dapsone; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Minocycline; Nocardia Infections; Skin Diseases, Infectious

A 45-year-old Japanese man developed a black eschar skin lesion and on the body, a number of erythematous seropapules 2 weeks after his return from South Africa. Within 24 h of treatment with minocycline he was afebrile and symptomatically much improved. Serological tests showed increased antibody titres to spotted fever group rickettsiae (SFGR). From the clinical and serological findings we consider this patient to be the first in Japan to have been infected with SFGR in Africa.

Topics: Antibodies, Bacterial; Humans; Immunoglobulin G; Immunoglobulin M; Japan; Male; Middle Aged; Minocycline; Rickettsia; Rickettsia Infections; Skin; Skin Diseases, Infectious; South Africa; Travel

Topics: Female; Humans; Middle Aged; Minocycline; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Skin Diseases, Infectious; Tetracyclines

A 47-year-old Japanese man suffering from T-cell leukemia was examined for multiple subcutaneous abscesses followed to abrasion wound on his right knee. The causative organism was clustered, fine-branched filaments in pus aspirated from the lesions, identified as Nocardia brasiliensis. Most of the lesions regressed from the combined therapy of sulfamethoxazole and trimethoprim, leaving an ulcer on the patient's left leg. The nocardiosis cases in Japan until 1984, including this one, were briefly surveyed.

Topics: Abscess; Drug Combinations; Humans; Japan; Lymphoma; Male; Middle Aged; Minocycline; Nocardia Infections; Skin Diseases, Infectious; Sulfamethoxazole; T-Lymphocytes; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.

Topics: Abscess; Aged; Amikacin; Drug Combinations; Facial Dermatoses; Humans; Lymphangitis; Male; Minocycline; Mycetoma; Nocardia; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Skin Ulcer; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Humans; Hyperplasia; Lymphatic Diseases; Male; Minocycline; Skin Diseases, Infectious; Tularemia

Topics: Female; Humans; Middle Aged; Minocycline; Pulmonary Eosinophilia; Skin Diseases, Infectious; Tetracyclines

Topics: Diagnosis, Differential; Humans; Male; Middle Aged; Minocycline; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Skin Diseases, Infectious; Sporotrichosis

Induration of the lower parts of the legs with abscess and ulcer formation occurred in a 60-year-old woman. Mycobacterium chelonei, a ubiquitous, saprophytic pathogen that uncommonly causes human disease, was cultured from biopsy material. Although spontaneous healing usually occurs in a few months with such infections, our patient's disease persisted for more than two years until control was achieved with minocycline hydrochloride.

Topics: Abscess; Female; Humans; Leg Ulcer; Middle Aged; Minocycline; Mycobacterium; Mycobacterium Infections; Skin Diseases, Infectious

Topics: Adult; Humans; Male; Minocycline; Mycobacterium Infections; Skin Diseases, Infectious; Tetracyclines

Topics: Female; Humans; Middle Aged; Minocycline; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Skin Diseases, Infectious; Tetracyclines

A sporotrichoid-like Mycobacterium kansasii infection of the skin is reported. This is the fifth reported case in the English literature of dermatological manifestations of a M. kansasii infection and the first reported case of a response to minocycline hydrochloride therapy.

Topics: Female; Humans; Middle Aged; Minocycline; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Skin Diseases, Infectious

Topics: Humans; Male; Middle Aged; Minocycline; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Skin Diseases, Infectious; Tetracyclines

Using a Steers replicator technique the in vitro sensitivities of 32 clinical isolates of Mycobacterium marinum to doxycycline and minocycline were tested. Of 32 strains, sensitivity to doxycycline ranged from 3 strains (9%) with a drug concentration of 2 microgram/ml to 11 strains (34%) at a concentration of 6 microgram/ml. Sensitivity to minocycline ranged from 2 strains (6%) at the 2microgram/ml concentration to 23 strains (72%) at the 8 microgram/ml concentration. Our data suggest that a significant percentage of M. marinum strains are sensitive to therapeutically achievable levels of doxycycline and minocycline. These drugs may prove clinically useful in treating infections caused by sensitive strains of M. marinum.

Topics: Doxycycline; Humans; Microbial Sensitivity Tests; Minocycline; Mycobacterium; Mycobacterium Infections; Skin Diseases, Infectious; Tetracyclines

Atypical acid-fast infections are not infrequent in the Gulf Coastal region. The development of erythematous papules within three or four weeks after aquatic exposure deserves such consideration. Deeper tissues may also become involved. This should signal a caution when considering the use of corticosteroid injections in such a suspicious lesion. Inasmuch as hypertrophic scar formation at a site of trauma must be considered in the differential diagnosis, it is important to secure histopathologic examination prior to treatment. While a surgical approach has been required for the most part, oral administration of minocycline hydrochloride has brought about healing in the patients reported herein. This article deals with only three cases. However, response was complete and without recurrence in each. Such therapy is recommended prior to the use of more drastic procedures.

Topics: Adult; Fingers; Granuloma; Hand; Humans; Male; Middle Aged; Minocycline; Mycobacterium Infections; Skin Diseases, Infectious; Swimming; Tetracyclines

Minocycline is a semi-synthetic tetracycline derivative which is well absorbed and distributed in body tissues and is suitable for twice daily administration. It appears to be as generally effective as other tetracyclines and analogues, but also to be effective in infections due to tetracycline-resistant staphylococci. Side-effects are typical of those of other tetracyclines, but minocycline has been associated with a high incidence of vertigo in some studies. On the other hand, minocycline appears to have little or no photosensitising potential. It is not yet clear whether minocycline can be safely used in patients with moderate or severe impairment of renal function, but if used in renal failure, the plasma urea concentration should be monitored.

Topics: Bacteria; Candida; Cholera; Humans; Malaria; Meningococcal Infections; Minocycline; Respiratory Tract Infections; Sexually Transmitted Diseases; Skin Diseases, Infectious; Tetracyclines; Urinary Tract Infections

Topics: Aged; Humans; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Tetracycline

Topics: Humans; Minocycline; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Tetracycline