Tetracyclines

The tetracyclines are slow-acting blood schizontocides that are used for short-term prophylaxis in areas with chloroquine and mefloquine resistance. Tetracyclines are particularly useful for the treatment of the acute malarial attack owing to multidrug-resistant strains of P. falciparum that also show partial resistance to quinine. Their relative slowness of action makes them ineffective as single agents for malaria treatment. Tetracycline or doxycycline usually is recommended. Tetracy-clines have marked activity against primary tissue schizonts of chloroquine-resistant P. falci-parum. Doxycycline is used by travelers for short-term prophylaxis of multidrug-resistant strains. Regimens for tetracycline and doxycycline are listed in Tables 39-1 and 39-2. Because of their adverse effects on bones and teeth, tetracyclines should not be given to pregnant women or children <8 years of age. Photosensitivity reactions or drug-induced superinfections may mandate their discontinuation.

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