Minocycline Hcl

Drug overview for MINOCYCLINE HCL (minocycline hcl):

Generic name: MINOCYCLINE HCL (MIN-oh-SYE-kleen)
Drug class: Tetracyclines
Therapeutic class: Anti-Infective Agents

Minocycline is a semisynthetic tetracycline antibiotic derived from tetracycline.

No enhanced Uses information available for this drug.

DRUG IMAGES

MINOCYCLINE 50 MG CAPSULE
MINOCYCLINE 100 MG CAPSULE
MINOCYCLINE 75 MG CAPSULE

The following indications for MINOCYCLINE HCL (minocycline hcl) have been approved by the FDA:

Indications:
Acne vulgaris
Actinomycosis
Acute bacterial otitis media
Anthrax
Bacterial pneumonia
Bacterial urinary tract infection
Bartonellosis
Brucellosis
Campylobacter fetus infection
Cholera
Fusospirochetal pharyngitis
Genitourinary Chlamydia trachomatis infection
Gingivostomatitis
Granuloma inguinale
Inclusion conjunctivitis caused by Chlamydia trachomatis
Listeriosis
Lymphogranuloma venereum
Meningococcal carrier
Mycoplasmal pneumonia
Pharyngitis
Plague
Psittacosis
Q fever
Relapsing fever
Rickettsialpox
Rocky Mountain spotted fever
Sinusitis
Skin and skin structure infection
Syphilis
Trachoma
Tularemia
Typhus infections
Upper respiratory pneumococcal infection
Ureaplasma urealyticum infection
Yaws

Professional Synonyms:
Acne simplex
Actinomycotic infection
Actinophytosis
Asiatic cholera
Asymptomatic carrier of Meningococcus
Asymptomatic Neisseria meningitidis carrier
Bacterial otitis media
Bartonella bacilliformis infection
Bedsonia pneumonia
Bilious typhoid of Griesinger
Black fever - Rocky Mountain spotted fever
Black measles
Blue disease
Blue fever
Bouba
Brazilian spotted fever
Camp fever
Campylobacter fetus infectious disease
Carrion's disease
Chronic contagious microbial inflammation
Colombian tick fever
Common acne
Conjunctivitis caused by chlamydia trachomatis
Contagious granular conjunctivitis
Deer-fly disease
Deer-fly fever
Donovanosis
Eaton agent pneumonia
Egyptian ophthalmia
Exanthematic typhus of Sao Paulo
Famine fever
Fourth venereal disease
Frambesia
Francis' disease
Fusospirochetal infection of the oropharynx
Genitourinary infection due to Chlamydia trachomatis
Granular lids
Granular ophthalmia
Granuloma venereum
Inclusion blennorrhea
Inclusion conjunctivitis
Infection by the bacteria Bacillus anthracis
Infection due to Calymmatobacterium granulomatis
Infection due to Listeria monocytogenes
Infection due to Rickettsia burnetii
Infection due to Rickettsia diaporica
Infection of skin and/or subcutaneous tissue
Jail fever
Kew Garden fever
Malta fever
Mexican spotted fever
Ornithosis
Pahvant Valley fever
Pahvant Valley plague
Parangi
Parrot fever
Pian
Pinta fever
Pneumococcal upper respiratory tract infection
Primary atypical pneumonia
Pudendal ulcer
Query fever
Rabbit fever
Recurrent fever
Sao Paulo fever
Sao Paulo typhus
Ship fever
Simple acne
Sinuitis
Skin and soft tissue skin infection
Spirillum fever
T-mycoplasma urealyticum infection
T-strain mycoplasma urealyticum infection
Throat inflammation
Tobia fever
Trachomatous follicular conjunctivitis
Typhinia
Typhus fever
Typhus infection
Typhus
Undulant fever
Upper respiratory Diplococcus pneumoniae infection
Upper respiratory infection from Fraenkel's Pneumococcus
Upper respiratory Streptococcus pneumoniae infection
Upper respiratory tract infection due to Pneumococcus
Upper respiratory tract infection due to S. pneumoniae
URI due to Fraenkel-Weichselbaum Pneumococcus
Vesicular rickettsiosis
Vincent's angina

The following dosing information is available for MINOCYCLINE HCL (minocycline hcl):

Dosing
Administration
MINOCYCLINE HCL
MINOCYCLINE HCL

Dosage of minocycline hydrochloride is expressed in terms of minocycline.

The usual adult oral dosage of minocycline is 200 mg initially, followed by 100 mg every 12 hours. Alternatively, if more frequent doses are preferred, adults may receive 100-200 mg of minocycline initially, followed by 50 mg 4 times daily.

The usual oral dosage of minocycline for children older than 8 years of age is 4 mg/kg initially, followed by 2 mg/kg every 12 hours.

For information on the use of minocycline hydrochloride for the treatment of periodontitis, see Minocycline (EENT) 52:04.04.

In patients with renal impairment, doses and/or frequency of administration of minocycline should be decreased in response to the degree of impairment. Some manufacturers state that dosage of oral minocycline should not exceed 200 mg daily in patients with impaired renal function.

No enhanced Administration information available for this drug.

Dosing information for MINOCYCLINE HCL
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
MINOCYCLINE 50 MG CAPSULE	Maintenance	Adults take 2 capsules (100 mg) by oral route every 12 hours
MINOCYCLINE 75 MG CAPSULE	Maintenance	Adults take 1 capsule (75 mg) by oral route once daily
MINOCYCLINE 100 MG CAPSULE	Maintenance	Adults take 1 capsule (100 mg) by oral route every 12 hours

Generic dosing information for MINOCYCLINE HCL
DRUG LABEL	DOSING TYPE	DOSING INSTRUCTIONS
MINOCYCLINE 75 MG CAPSULE	Maintenance	Adults take 1 capsule (75 mg) by oral route once daily
MINOCYCLINE 50 MG CAPSULE	Maintenance	Adults take 2 capsules (100 mg) by oral route every 12 hours
MINOCYCLINE 100 MG CAPSULE	Maintenance	Adults take 1 capsule (100 mg) by oral route every 12 hours

The following drug interaction information is available for MINOCYCLINE HCL (minocycline hcl):

Contraindicated
Severe
Moderate

There are 2 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction	Drug Names
Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)	VIVOTIF
Selected Retinoids (Systemic)/Tetracyclines SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Both systemic tetracyclines(1-4,14) and systemic retinoids(5-14) have been independently associated with medication-induced intracranial hypertension. CLINICAL EFFECTS: The concurrent use of oral retinoids(5-12) with tetracyclines has been associated with pseudotumor cerebri (benign intracranial hypertension). Early signs of pseudotumor cerebri include papilledema (inflammation of the optic nerve), headache, nausea, vomiting, and visual disturbances such as blurred vision, double vision, and loss of vision.(15) PREDISPOSING FACTORS: Women of childbearing age who are overweight or have a previous history of intracranial hypertension are at a greater risk of developing intracranial hypertension.(15) PATIENT MANAGEMENT: The UK(5) and US(6) manufacturers of acitretin state state that concurrent use with tetracyclines is contraindicated. The UK manufacturer of isotretinoin states that concurrent use with tetracyclines is contraindicated.(7) The US manufacturer of isotretinoin states that the concurrent use of tetracyclines should be avoided.(8) The US manufacturer of minocycline states that the administration of isotretinoin should be avoided shortly before, during and shortly after minocycline therapy.(2) The UK manufacturers of oral tretinoin and alitretinoin states that concurrent use with tetracyclines is contraindicated.(9,11) The Canadian manufacturer of palovarotene states that coadministration of tetracycline derivatives should be avoided.(12) Patients who present with symptoms of pseudotumor cerebri should be screened for papilledema. If papilledema is present, they should discontinue the drug and be referred to a neurologist for further treatment.(5-13) DISCUSSION: The concurrent use of isotretinoin and tetracyclines has been associated with pseudotumor cerebri.(5-13) A review of ocular side effects from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the Food and Drug Administration, and medical journals from 1979 to 2003 found 6 patients who developed intracranial hypertension while taking concurrent minocycline or tetracycline with tretinoin, acitretin, or etretinate.(13)	ABSORICA, ABSORICA LD, ACCUTANE, ACITRETIN, AMNESTEEM, CLARAVIS, ISOTRETINOIN, RETINOIC ACID, SOHONOS, TRETINOIN, TRETINOIN ACID, ZENATANE

Drug Interaction

Drug Names

Live Typhoid Vaccine/Antimicrobials

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1)

CLINICAL EFFECTS: Vaccination may be ineffective.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3)

DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3)

VIVOTIF

Selected Retinoids (Systemic)/Tetracyclines

SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

MECHANISM OF ACTION: Both systemic tetracyclines(1-4,14) and systemic retinoids(5-14) have been independently associated with medication-induced intracranial hypertension.

CLINICAL EFFECTS: The concurrent use of oral retinoids(5-12) with tetracyclines has been associated with pseudotumor cerebri (benign intracranial hypertension). Early signs of pseudotumor cerebri include papilledema (inflammation of the optic nerve), headache, nausea, vomiting, and visual disturbances such as blurred vision, double vision, and loss of vision.(15)

PREDISPOSING FACTORS: Women of childbearing age who are overweight or have a previous history of intracranial hypertension are at a greater risk of developing intracranial hypertension.(15)

PATIENT MANAGEMENT: The UK(5) and US(6) manufacturers of acitretin state state that concurrent use with tetracyclines is contraindicated. The UK manufacturer of isotretinoin states that concurrent use with tetracyclines is contraindicated.(7) The US manufacturer of isotretinoin states that the concurrent use of tetracyclines should be avoided.(8)

The US manufacturer of minocycline states that the administration of isotretinoin should be avoided shortly before, during and shortly after minocycline therapy.(2) The UK manufacturers of oral tretinoin and alitretinoin states that concurrent use with tetracyclines is contraindicated.(9,11) The Canadian manufacturer of palovarotene states that coadministration of tetracycline derivatives should be avoided.(12)

Patients who present with symptoms of pseudotumor cerebri should be screened for papilledema. If papilledema is present, they should discontinue the drug and be referred to a neurologist for further treatment.(5-13)

DISCUSSION: The concurrent use of isotretinoin and tetracyclines has been associated with pseudotumor cerebri.(5-13) A review of ocular side effects from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the Food and Drug Administration, and medical journals from 1979 to 2003 found 6 patients who developed intracranial hypertension while taking concurrent minocycline or tetracycline with tretinoin, acitretin, or etretinate.(13)

ABSORICA, ABSORICA LD, ACCUTANE, ACITRETIN, AMNESTEEM, CLARAVIS, ISOTRETINOIN, RETINOIC ACID, SOHONOS, TRETINOIN, TRETINOIN ACID, ZENATANE

There are 6 severe interactions. These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.

Drug Interaction	Drug Names
Topical Tretinoin/Tetracyclines SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. CLINICAL EFFECTS: Concurrent use of topical tretinoin with tetracyclines may increase the risk of phototoxicity(1) in some patients.(2) PREDISPOSING FACTORS: Patients using topical tretinoin for the treatment of photodamage may be predisposed to photosensitivity.(2) PATIENT MANAGEMENT: Concurrent use of topical tretinoin and tetracycline is standard practice in the treatment of acne.(3) However, patients taking tetracyclines should not use topical tretinoin (e.g Renova) for the treatment of photodamage.(1,2) DISCUSSION: The concurrent use of topical tretinoin and tetracyclines may result in an increased risk of phototoxicity.(1,2)	KATARYA, KATARYAXN, KETARYA, KEVARYA, KUTARYAXM, KUTARYAXMPA, KUVARYA, KUVARYE, MECORIX, MECORIX HP, MECORIX PLUS, MEKAM, MEKAM HP, MELIDU, MELONDIS, MELONDIS PLUS, MOLEXI, MYTHIUS, REFISSA, RENOVA, RENOVA PUMP, TRETINOIN, TRI-LUMA, YAXATARXYN, YOKATAR
Cholera Vaccine Live/Selected Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine.(1) CLINICAL EFFECTS: Concurrent or recent antibiotic use may make the cholera vaccine ineffective.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of live cholera vaccine states that it should not be administered to patients who have received antibiotics within 14 days prior to vaccination.(1) If antimalarial prophylaxis with chloroquine is required, administer the live cholera vaccine at least 10 days before beginning chloroquine.(1) Antibiotics linked to this monograph are: macrolides, quinolones, tetracyclines, ampicillin, cefprozil, chloramphenicol, furazolidone, sulfamethoxazole-trimethoprim, and sulfametrole-trimethoprim.(2,3) DISCUSSION: Antibiotics with activity against Vibrio cholerae may attenuate the immunization response to the live cholera vaccine, rendering the vaccine ineffective.	VAXCHORA ACTIVE COMPONENT, VAXCHORA VACCINE
Aminolevulinic Acid/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Aminolevulinic acid, anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are all known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of aminolevulinic acid in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1) DISCUSSION: Because of the risk of increased photosensitivity, the US manufacturer states that aminolevulinic acid should be avoided in patients receiving photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides for 24 hours before and after administration of aminolevulinic acid.(1)	AMINOLEVULINIC ACID HCL, GLEOLAN
Porfimer/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Porfimer causes photosensitivity due to residual drug which is present in all parts of the skin. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of porfimer in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: Patients with any hepatic impairment and patients with severe renal impairment have reduced drug elimination and may remain photosensitive for 90 days or longer.(1) PATIENT MANAGEMENT: The US manufacturer of porfimer states that concurrent use of porfimer with photosensitizers including anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1) Since the photosensitive effect of porfimer may persist for at least 30 days (and for 90 days in some patients), it would be prudent to avoid other photosensitizing agents for at least 30 days after administration of porfimer. DISCUSSION: All patients who have received porfimer become photosensitive. It is unknown what the risk of photosensitivity reactions is when porfimer is used concurrently with other photosensitizing agents. When porfimer was used in clinical trials, photosensitivity reactions occurred in about 20% of cancer patients and in 69% of high-grade dysplasia in Barretts esophagus patients. Most of the reactions were mild to moderate erythema, but they also included swelling, pruritus, burning sensation, feeling hot, or blisters. The majority of reactions occurred within 90 days of porfimer administration.(1)	PHOTOFRIN
Methoxsalen/Selected Photosensitizers SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Methoxsalen causes photosensitivity due to residual drug which is present in all parts of the skin from photopheresis. Anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides are other known photosensitizers.(1) CLINICAL EFFECTS: Concurrent use of methoxsalen in patients taking anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides may increase the risk of phototoxicity.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The US manufacturer of methoxsalen states that concurrent use of methoxsalen with anthralin, coal tar and derivatives, fluoroquinolones, griseofulvin, organic staining dyes (such as methylene blue, rose bengal, or toluidine blue), phenothiazines, selected NSAIDs (such as diclofenac, ketoprofen, nabumetone, naproxen, piroxicam, and tiaprofenic acid), St. John's wort, sulfonamides, sulfonylureas, tetracyclines, and thiazides should be avoided.(1) DISCUSSION: All patients who have received methoxsalen become photosensitive. It is unknown what the risk of photosensitivity reactions is when methoxsalen is used concurrently with other photosensitizing agents.(1)	METHOXSALEN, UVADEX
Fecal Microbiota Spores/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores.	VOWST

There are 4 moderate interactions. The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.

Drug Interaction	Drug Names
Tetracyclines/Divalent & Trivalent Cations SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Di- and trivalent cations may form chelation complexes with tetracyclines, preventing their absorption.(1,2) CLINICAL EFFECTS: Simultaneous administration of di- or trivalent cations may result in decreased levels of and therapeutics effects from tetracyclines. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Administer tetracyclines at least two hours before or after the di- or trivalent cations. When used for the treatment of H. pylori infection, tetracyclines and bismuth should be given simultaneously. The US manufacturer of omadacycline states to fast for at least four hours, administer omadacycline, and then wait four hours before taking di- or trivalent cations.(21) DISCUSSION: Concurrent administration of aluminum hydroxide or divalent cations (such as calcium, magnesium, or zinc) has been shown to significantly decrease the gastrointestinal absorption of tetracycline.(3-5) Concurrent administration of tetracycline and magnesium-aluminum hydroxide gel has been shown to decrease the tetracycline area-under-curve (AUC) by 90%.(6) Magnesium-aluminum silicate has been shown to decrease the AUC of tetracycline by 27%.(7) Demeclocycline(8,9) methacycline,(10) chlortetracycline,(11) and oxytetracycline(10,12) have been shown to interact with aluminum hydroxide and/or dairy products. Doxycycline has been reported to interact with aluminum hydroxide gel.(13) Aluminum magnesium hydroxide has been shown to decrease doxycycline absorption by 84%.(14) Minocycline absorption has been shown to be impaired by aluminum, calcium, and magnesium.(15) Bismuth subsalicylate has been shown to decrease absorption of doxycycline and tetracycline by 37%(16) and 34%,(17) respectively. Since sucralfate is an aluminum salt of a sulfated disaccharide, it may also prevent absorption of tetracyclines. This complex has been used to provide site-specific delivery of tetracycline to gastric ulcers in the treatment of Helicobacter pylori gastric ulcer disease and may be useful in some indications.(18) Quinapril tablets contain a high percentage of magnesium and have been shown to decrease the absorption of tetracycline by 28-37%.(19) Lanthanum is expected to interact with tetracyclines as well.(20)	ACCRUFER, ALUMINUM HYDROXIDE, ATTAPULGITE, AUROVELA 24 FE, AUROVELA FE, AURYXIA, BALCOLTRA, BISMUTH CITRATE, BISMUTH SUBSALICYLATE, BLISOVI 24 FE, BLISOVI FE, CALCIUM ACETATE, CALCIUM CHLORIDE, CALCIUM GLUCONATE, CALCIUM GLUCONATE MONOHYDRATE, CARAFATE, CHARLOTTE 24 FE, CLENPIQ, FEIRZA, FERRIC CITRATE, FINZALA, FOSRENOL, GEMMILY, HAILEY 24 FE, HAILEY FE, JOYEAUX, JUNEL FE, JUNEL FE 24, KAITLIB FE, KAOLIN, LANTHANUM CARBONATE, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEVONORG-ETH ESTRAD-FE BISGLYC, LO LOESTRIN FE, LOESTRIN FE, MAGNESIUM CHLORIDE, MAGNESIUM CITRATE, MAGNESIUM OXIDE, MAGNESIUM SULFATE, MERZEE, MIBELAS 24 FE, MICROGESTIN FE, MINZOYA, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRONE-E.ESTRADIOL-IRON, SOD SULF-POTASS SULF-MAG SULF, SUCRALFATE, SUFLAVE, SUPREP, SUTAB, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-LEGEST FE, VELPHORO, WYMZYA FE, XARAH FE, XELRIA FE, ZINC CHLORIDE, ZINC OXIDE, ZINC SULFATE
Contraceptives/Tetracyclines; Tigecycline SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Not established. CLINICAL EFFECTS: Reduced pharmacologic effects of oral contraceptives with resultant breakthrough bleeding and pregnancy may occur. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Current guidelines suggest that additional precautions are not necessary when non-enzyme inducing antibiotics are used concurrently with hormonal contraceptives; however, some patients may still prefer to use an additional method of contraception. DISCUSSION: Evidence for this interaction is limited and conflicting; however, the CDC and the Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit no longer recommend use of a backup contraceptive method during use of a non-enzyme inducing antibiotic. Pregnancy has been reported following the addition of tetracycline to oral contraceptive therapy.(1) In contrast, a study in 7 healthy women found no effect of tetracycline on ethinyl estradiol or norethindrone levels.(2) A study in 24 healthy women found no significant effects of doxycycline on ethinyl estradiol, norethindrone, or progesterone levels. However, the authors noted that there large inter-patient and inter-patient variability in these levels and that the interaction may just manifest itself in a small proportion of women.(3)	2-METHOXYESTRADIOL, AFIRMELLE, ALTAVERA, ALYACEN, AMETHIA, AMETHYST, APRI, ARANELLE, ASHLYNA, AUBRA, AUBRA EQ, AUROVELA, AUROVELA 24 FE, AUROVELA FE, AVIANE, AYUNA, AZURETTE, BALCOLTRA, BALZIVA, BEYAZ, BLISOVI 24 FE, BLISOVI FE, BRIELLYN, CAMILA, CAMRESE, CAMRESE LO, CAZIANT, CHARLOTTE 24 FE, CHATEAL EQ, CRYSELLE, CYRED, CYRED EQ, DASETTA, DAYSEE, DEBLITANE, DESOGESTR-ETH ESTRAD ETH ESTRA, DIETHYLSTILBESTROL, DOLISHALE, DROSPIRENONE-ETH ESTRA-LEVOMEF, DROSPIRENONE-ETHINYL ESTRADIOL, ELINEST, ELLA, EMZAHH, ENPRESSE, ENSKYCE, ERRIN, ESTARYLLA, ESTRADIOL, ESTRADIOL BENZOATE, ESTRADIOL CYPIONATE, ESTRADIOL HEMIHYDRATE, ESTRADIOL HEMIHYDRATE MICRO, ESTRADIOL MICRONIZED, ESTRADIOL VALERATE, ESTRIOL, ESTRIOL MICRONIZED, ESTRONE, ETHINYL ESTRADIOL, ETHYNODIOL-ETHINYL ESTRADIOL, FALMINA, FEIRZA, FEMLYV, FINZALA, GEMMILY, HAILEY, HAILEY 24 FE, HAILEY FE, HEATHER, ICLEVIA, INCASSIA, ISIBLOOM, JAIMIESS, JASMIEL, JENCYCLA, JOLESSA, JOYEAUX, JULEBER, JUNEL, JUNEL FE, JUNEL FE 24, KAITLIB FE, KALLIGA, KARIVA, KELNOR 1-35, KELNOR 1-50, KURVELO, LARIN, LARIN 24 FE, LARIN FE, LAYOLIS FE, LEENA, LESSINA, LEVONEST, LEVONORG-ETH ESTRAD ETH ESTRAD, LEVONORG-ETH ESTRAD-FE BISGLYC, LEVONORGESTREL-ETH ESTRADIOL, LEVORA-28, LO LOESTRIN FE, LO-ZUMANDIMINE, LOESTRIN, LOESTRIN FE, LOJAIMIESS, LORYNA, LOW-OGESTREL, LUTERA, LYLEQ, LYZA, MARLISSA, MERZEE, MIBELAS 24 FE, MICROGESTIN, MICROGESTIN FE, MILI, MINZOYA, MONO-LINYAH, NATAZIA, NECON, NEXTSTELLIS, NIKKI, NORA-BE, NORETHIN-ETH ESTRA-FERROUS FUM, NORETHINDRON-ETHINYL ESTRADIOL, NORETHINDRONE, NORETHINDRONE-E.ESTRADIOL-IRON, NORGESTIMATE-ETHINYL ESTRADIOL, NORTREL, NYLIA, OCELLA, ORTHO TRI-CYCLEN, ORTHO-NOVUM, PHILITH, PIMTREA, PORTIA, RECLIPSEN, RIVELSA, SAFYRAL, SETLAKIN, SHAROBEL, SIMLIYA, SIMPESSE, SLYND, SPRINTEC, SRONYX, SYEDA, TARINA 24 FE, TARINA FE, TARINA FE 1-20 EQ, TAYTULLA, TILIA FE, TRI-ESTARYLLA, TRI-LEGEST FE, TRI-LINYAH, TRI-LO-ESTARYLLA, TRI-LO-MARZIA, TRI-LO-MILI, TRI-LO-SPRINTEC, TRI-MILI, TRI-SPRINTEC, TRI-VYLIBRA, TRI-VYLIBRA LO, TRIVORA-28, TULANA, TURQOZ, TYBLUME, VALTYA, VELIVET, VESTURA, VIENVA, VIORELE, VOLNEA, VYFEMLA, VYLIBRA, WERA, WYMZYA FE, XARAH FE, XELRIA FE, YASMIN 28, YAZ, ZARAH, ZOVIA 1-35, ZUMANDIMINE
Digoxin, Oral/Tetracyclines SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: In approximately 10% of patients receiving digoxin, a considerable amount of an administered dose of the drug is metabolized by GI bacteria to inactive digoxin reduction products (DRPs). Concomitant administration of tetracycline may alter the GI flora, enabling an increased amount of digoxin to be absorbed. CLINICAL EFFECTS: Increased serum digoxin levels with possible toxicity may occur. This effect may persist for several months after tetracycline is discontinued. Symptoms of digoxin toxicity can include anorexia, nausea, vomiting, headache, fatigue, malaise, drowsiness, generalized muscle weakness, disorientation, hallucinations, visual disturbances, and arrhythmias. PREDISPOSING FACTORS: Low body weight, advanced age, impaired renal function, hypokalemia, hypercalcemia, and/or hypomagnesemia may increase the risk of digoxin toxicity. PATIENT MANAGEMENT: Monitor serum digoxin levels and observe the patient for toxicity. The dosage of digoxin may need to be decreased by 30-50% or the frequency of administration may be reduced.(3) DISCUSSION: Approximately 10% of the patients receiving digoxin metabolize 30% or more of an ingested dose of digoxin to inactive DRPs. Concurrent current administration of tetracycline may alter the GI flora, decreasing the conversion of digoxin to DRPs. In these patients this could produce an increase in plasma digoxin concentration. The effect of tetracycline on the metabolism of digoxin to DRPs may persist for several months after the antibiotic is discontinued. Concomitant administration of tetracycline and digoxin increased the digoxin serum concentration 100%. (3)	DIGITEK, DIGOXIN, DIGOXIN MICRONIZED, LANOXIN
Coumarin Anticoagulants/Tetracyclines SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown. Tetracyclines may interfere with vitamin-K producing gut flora. CLINICAL EFFECTS: The addition of a tetracycline to a patient maintained on a coumarin anticoagulant may result in increased anticoagulant effects, including bleeding. PREDISPOSING FACTORS: he risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs). PATIENT MANAGEMENT: Patients maintained on coumarin anticoagulants should be closely monitored when tetracyclines are initiated and discontinued. The dosage of the anticoagulant may need to be adjusted. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug. DISCUSSION: In a retrospective review of patients receiving either acenocoumarol or phenprocoumon, use of doxycycline and tetracycline was associated with relative risk of major bleeding of 3 and 9, respectively.(1) There are several case reports of bleeding following the addition of doxycycline(2-4) and tetracycline(5,6) to warfarin therapy.	DICUMAROL, JANTOVEN, WARFARIN SODIUM

The following contraindication information is available for MINOCYCLINE HCL (minocycline hcl):

Overview
Contraindicated
Severe
Moderate

Drug contraindication overview.

No enhanced Contraindications information available for this drug.

There are 1 contraindications. Absolute contraindication.

Contraindication List
Pregnancy

There are 3 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Clostridioides difficile infection
Esophageal dysmotility
Idiopathic intracranial hypertension

There are 4 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
Disease of liver
Kidney disease with reduction in glomerular filtration rate (GFr)
Myasthenia gravis
Systemic lupus erythematosus

The following adverse reaction information is available for MINOCYCLINE HCL (minocycline hcl):

Overview
Severe
Less Severe

Adverse reaction overview.

No enhanced Common Adverse Effects information available for this drug.

There are 45 severe adverse reactions.

More Frequent	Less Frequent
Dental discoloration	Urticaria

Rare/Very Rare
Abnormal hepatic function tests Acute eruptions of skin Acute hepatic failure Acute pancreatitis Agranulocytosis Anaphylaxis Angioedema Asthma exacerbation Autoimmune hepatitis Balanitis Cholestasis Clostridioides difficile infection DRESS syndrome Dyspnea Eosinophilia Erythema multiforme Erythema nodosum Esophagitis Exfoliative dermatitis Hemolytic anemia Hepatitis Hyperbilirubinemia Hypersensitivity drug reaction Hypersensitivity pneumonitis Idiopathic intracranial hypertension Interstitial nephritis Kidney disease with reduction in glomerular filtration rate (GFr) Leukopenia Lupus-like syndrome Lymphadenopathy Myocarditis Nephritis Neutropenic disorder Pancytopenia Pericarditis Seizure disorder Serum sickness Stevens-johnson syndrome Sweet's syndrome Thrombocytopenic disorder Thyroid carcinoma Tooth enamel hypoplasia Vasculitis

Rare/Very Rare

Abnormal hepatic function tests
Acute eruptions of skin
Acute hepatic failure
Acute pancreatitis
Agranulocytosis
Anaphylaxis
Angioedema
Asthma exacerbation
Autoimmune hepatitis
Balanitis
Cholestasis
Clostridioides difficile infection
DRESS syndrome
Dyspnea
Eosinophilia
Erythema multiforme
Erythema nodosum
Esophagitis
Exfoliative dermatitis
Hemolytic anemia
Hepatitis
Hyperbilirubinemia
Hypersensitivity drug reaction
Hypersensitivity pneumonitis
Idiopathic intracranial hypertension
Interstitial nephritis
Kidney disease with reduction in glomerular filtration rate (GFr)
Leukopenia
Lupus-like syndrome
Lymphadenopathy
Myocarditis
Nephritis
Neutropenic disorder
Pancytopenia
Pericarditis
Seizure disorder
Serum sickness
Stevens-johnson syndrome
Sweet's syndrome
Thrombocytopenic disorder
Thyroid carcinoma
Tooth enamel hypoplasia
Vasculitis

There are 43 less severe adverse reactions.

More Frequent	Less Frequent
Fatigue Headache disorder Nausea Pruritus of skin Vomiting	Arthralgia Arthritis CNS toxicity Drowsy Dyschromia Fever Mouth discoloration Mouth irritation Myalgia Nail discoloration Oral candidiasis Saliva discoloration Sputum discoloration Tear discoloration Tongue discoloration Vertigo Xerostomia

Rare/Very Rare
Alopecia Anorexia Ataxia Cough Diarrhea Dizziness Dyspepsia Dysphagia Enterocolitis Glossitis Hearing loss Hypoesthesia Malaise Oligospermia Paresthesia Skin photosensitivity Skin rash Stomatitis Tinnitus Visual changes Vulvovaginitis

The following precautions are available for MINOCYCLINE HCL (minocycline hcl):

Pediatric
Pregnant
Lactation
Geriatric

No enhanced Pediatric Use information available for this drug.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

No enhanced Pregnancy information available for this drug.

No enhanced Lactation information available for this drug.

No enhanced Geriatric Use information available for this drug.

The following icd codes are available for MINOCYCLINE HCL (minocycline hcl)'s list of indications:

Acne vulgaris
L70.0	Acne vulgaris
Actinomycosis
A42	Actinomycosis
A42.0	Pulmonary actinomycosis
A42.1	Abdominal actinomycosis
A42.2	Cervicofacial actinomycosis
A42.7	Actinomycotic sepsis
A42.8	Other forms of actinomycosis
A42.81	Actinomycotic meningitis
A42.82	Actinomycotic encephalitis
A42.89	Other forms of actinomycosis
A42.9	Actinomycosis, unspecified
Acute bacterial otitis media
H66	Suppurative and unspecified otitis media
H66.0	Acute suppurative otitis media
H66.00	Acute suppurative otitis media without spontaneous rupture of ear drum
H66.001	Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
H66.002	Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
H66.003	Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
H66.004	Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
H66.005	Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear
H66.006	Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
H66.007	Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, unspecified ear
H66.009	Acute suppurative otitis media without spontaneous rupture of ear drum, unspecified ear
H66.01	Acute suppurative otitis media with spontaneous rupture of ear drum
H66.011	Acute suppurative otitis media with spontaneous rupture of ear drum, right ear
H66.012	Acute suppurative otitis media with spontaneous rupture of ear drum, left ear
H66.013	Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral
H66.014	Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear
H66.015	Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear
H66.016	Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral
H66.017	Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear
H66.019	Acute suppurative otitis media with spontaneous rupture of ear drum, unspecified ear
H66.4	Suppurative otitis media, unspecified
H66.40	Suppurative otitis media, unspecified, unspecified ear
H66.41	Suppurative otitis media, unspecified, right ear
H66.42	Suppurative otitis media, unspecified, left ear
H66.43	Suppurative otitis media, unspecified, bilateral
H66.9	Otitis media, unspecified
H66.90	Otitis media, unspecified, unspecified ear
H66.91	Otitis media, unspecified, right ear
H66.92	Otitis media, unspecified, left ear
H66.93	Otitis media, unspecified, bilateral
Anthrax
A22	Anthrax
A22.0	Cutaneous anthrax
A22.1	Pulmonary anthrax
A22.2	Gastrointestinal anthrax
A22.7	Anthrax sepsis
A22.8	Other forms of anthrax
A22.9	Anthrax, unspecified
Bacterial pneumonia
J15.9	Unspecified bacterial pneumonia
Bacterial urinary tract infection
N30.0	Acute cystitis
N30.00	Acute cystitis without hematuria
N30.01	Acute cystitis with hematuria
N30.9	Cystitis, unspecified
N30.90	Cystitis, unspecified without hematuria
N30.91	Cystitis, unspecified with hematuria
N39.0	Urinary tract infection, site not specified
O23.0	Infections of kidney in pregnancy
O23.00	Infections of kidney in pregnancy, unspecified trimester
O23.01	Infections of kidney in pregnancy, first trimester
O23.02	Infections of kidney in pregnancy, second trimester
O23.03	Infections of kidney in pregnancy, third trimester
O23.1	Infections of bladder in pregnancy
O23.10	Infections of bladder in pregnancy, unspecified trimester
O23.11	Infections of bladder in pregnancy, first trimester
O23.12	Infections of bladder in pregnancy, second trimester
O23.13	Infections of bladder in pregnancy, third trimester
O23.2	Infections of urethra in pregnancy
O23.20	Infections of urethra in pregnancy, unspecified trimester
O23.21	Infections of urethra in pregnancy, first trimester
O23.22	Infections of urethra in pregnancy, second trimester
O23.23	Infections of urethra in pregnancy, third trimester
O23.3	Infections of other parts of urinary tract in pregnancy
O23.30	Infections of other parts of urinary tract in pregnancy, unspecified trimester
O23.31	Infections of other parts of urinary tract in pregnancy, first trimester
O23.32	Infections of other parts of urinary tract in pregnancy, second trimester
O23.33	Infections of other parts of urinary tract in pregnancy, third trimester
O23.4	Unspecified infection of urinary tract in pregnancy
O23.40	Unspecified infection of urinary tract in pregnancy, unspecified trimester
O23.41	Unspecified infection of urinary tract in pregnancy, first trimester
O23.42	Unspecified infection of urinary tract in pregnancy, second trimester
O23.43	Unspecified infection of urinary tract in pregnancy, third trimester
O23.90	Unspecified genitourinary tract infection in pregnancy, unspecified trimester
O23.91	Unspecified genitourinary tract infection in pregnancy, first trimester
O23.92	Unspecified genitourinary tract infection in pregnancy, second trimester
O23.93	Unspecified genitourinary tract infection in pregnancy, third trimester
P39.3	Neonatal urinary tract infection
T83	Complications of genitourinary prosthetic devices, implants and grafts
T83.5	Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system
T83.51	Infection and inflammatory reaction due to urinary catheter
T83.59	Infection and inflammatory reaction due to prosthetic device, implant and graft in urinary system
T83.6	Infection and inflammatory reaction due to prosthetic device, implant and graft in genital tract
Bartonellosis
A44	Bartonellosis
A44.0	Systemic bartonellosis
A44.1	Cutaneous and mucocutaneous bartonellosis
A44.8	Other forms of bartonellosis
A44.9	Bartonellosis, unspecified
Brucellosis
A23	Brucellosis
A23.0	Brucellosis due to brucella melitensis
A23.1	Brucellosis due to brucella abortus
A23.2	Brucellosis due to brucella suis
A23.3	Brucellosis due to brucella canis
A23.8	Other brucellosis
A23.9	Brucellosis, unspecified
Campylobacter fetus infection
B96.89	Other specified bacterial agents as the cause of diseases classified elsewhere
Cholera
A00	Cholera
A00.0	Cholera due to vibrio cholerae 01, biovar cholerae
A00.1	Cholera due to vibrio cholerae 01, biovar eltor
A00.9	Cholera, unspecified
Fusospirochetal pharyngitis
A69.1	Other vincent's infections
Genitourinary chlamydia trachomatis infection
A56.0	Chlamydial infection of lower genitourinary tract
A56.00	Chlamydial infection of lower genitourinary tract, unspecified
A56.01	Chlamydial cystitis and urethritis
A56.02	Chlamydial vulvovaginitis
A56.09	Other chlamydial infection of lower genitourinary tract
A56.1	Chlamydial infection of pelviperitoneum and other genitourinary organs
A56.11	Chlamydial female pelvic inflammatory disease
A56.19	Other chlamydial genitourinary infection
A56.2	Chlamydial infection of genitourinary tract, unspecified
Gingivostomatitis
K05.10	Chronic gingivitis, plaque induced
Granuloma inguinale
A58	Granuloma inguinale
Inclusion conjunctivitis caused by chlamydia trachomatis
A74.0	Chlamydial conjunctivitis
Listeriosis
A32	Listeriosis
A32.0	Cutaneous listeriosis
A32.1	Listerial meningitis and meningoencephalitis
A32.11	Listerial meningitis
A32.12	Listerial meningoencephalitis
A32.7	Listerial sepsis
A32.8	Other forms of listeriosis
A32.81	Oculoglandular listeriosis
A32.82	Listerial endocarditis
A32.89	Other forms of listeriosis
A32.9	Listeriosis, unspecified
P37.2	Neonatal (disseminated) listeriosis
Lymphogranuloma venereum
A55	Chlamydial lymphogranuloma (venereum)
Meningococcal carrier
Z22.31	Carrier of bacterial disease due to meningococci
Mycoplasmal pneumonia
J15.7	Pneumonia due to mycoplasma pneumoniae
Pharyngitis
J02	Acute pharyngitis
J02.0	Streptococcal pharyngitis
J02.8	Acute pharyngitis due to other specified organisms
J02.9	Acute pharyngitis, unspecified
Plague
A20	Plague
A20.0	Bubonic plague
A20.1	Cellulocutaneous plague
A20.2	Pneumonic plague
A20.3	Plague meningitis
A20.7	Septicemic plague
A20.8	Other forms of plague
A20.9	Plague, unspecified
Psittacosis
A70	Chlamydia psittaci infections
Q fever
A78	Q fever
Relapsing fever
A68	Relapsing fevers
A68.0	Louse-borne relapsing fever
A68.9	Relapsing fever, unspecified
Rickettsialpox
A79.1	Rickettsialpox due to rickettsia akari
Rocky mountain spotted fever
A77.0	Spotted fever due to rickettsia rickettsii
Sinusitis
J01	Acute sinusitis
J01.0	Acute maxillary sinusitis
J01.00	Acute maxillary sinusitis, unspecified
J01.01	Acute recurrent maxillary sinusitis
J01.1	Acute frontal sinusitis
J01.10	Acute frontal sinusitis, unspecified
J01.11	Acute recurrent frontal sinusitis
J01.2	Acute ethmoidal sinusitis
J01.20	Acute ethmoidal sinusitis, unspecified
J01.21	Acute recurrent ethmoidal sinusitis
J01.3	Acute sphenoidal sinusitis
J01.30	Acute sphenoidal sinusitis, unspecified
J01.31	Acute recurrent sphenoidal sinusitis
J01.4	Acute pansinusitis
J01.40	Acute pansinusitis, unspecified
J01.41	Acute recurrent pansinusitis
J01.8	Other acute sinusitis
J01.80	Other acute sinusitis
J01.81	Other acute recurrent sinusitis
J01.9	Acute sinusitis, unspecified
J01.90	Acute sinusitis, unspecified
J01.91	Acute recurrent sinusitis, unspecified
J32	Chronic sinusitis
J32.0	Chronic maxillary sinusitis
J32.1	Chronic frontal sinusitis
J32.2	Chronic ethmoidal sinusitis
J32.3	Chronic sphenoidal sinusitis
J32.4	Chronic pansinusitis
J32.8	Other chronic sinusitis
J32.9	Chronic sinusitis, unspecified
Skin and skin structure infection
H05.01	Cellulitis of orbit
H05.011	Cellulitis of right orbit
H05.012	Cellulitis of left orbit
H05.013	Cellulitis of bilateral orbits
H05.019	Cellulitis of unspecified orbit
H60.1	Cellulitis of external ear
H60.10	Cellulitis of external ear, unspecified ear
H60.11	Cellulitis of right external ear
H60.12	Cellulitis of left external ear
H60.13	Cellulitis of external ear, bilateral
K12.2	Cellulitis and abscess of mouth
L03	Cellulitis and acute lymphangitis
L03.0	Cellulitis and acute lymphangitis of finger and toe
L03.01	Cellulitis of finger
L03.011	Cellulitis of right finger
L03.012	Cellulitis of left finger
L03.019	Cellulitis of unspecified finger
L03.03	Cellulitis of toe
L03.031	Cellulitis of right toe
L03.032	Cellulitis of left toe
L03.039	Cellulitis of unspecified toe
L03.1	Cellulitis and acute lymphangitis of other parts of limb
L03.11	Cellulitis of other parts of limb
L03.111	Cellulitis of right axilla
L03.112	Cellulitis of left axilla
L03.113	Cellulitis of right upper limb
L03.114	Cellulitis of left upper limb
L03.115	Cellulitis of right lower limb
L03.116	Cellulitis of left lower limb
L03.119	Cellulitis of unspecified part of limb
L03.2	Cellulitis and acute lymphangitis of face and neck
L03.21	Cellulitis and acute lymphangitis of face
L03.211	Cellulitis of face
L03.22	Cellulitis and acute lymphangitis of neck
L03.221	Cellulitis of neck
L03.3	Cellulitis and acute lymphangitis of trunk
L03.31	Cellulitis of trunk
L03.311	Cellulitis of abdominal wall
L03.312	Cellulitis of back [any part except buttock]
L03.313	Cellulitis of chest wall
L03.314	Cellulitis of groin
L03.315	Cellulitis of perineum
L03.316	Cellulitis of umbilicus
L03.317	Cellulitis of buttock
L03.319	Cellulitis of trunk, unspecified
L03.8	Cellulitis and acute lymphangitis of other sites
L03.81	Cellulitis of other sites
L03.811	Cellulitis of head [any part, except face]
L03.818	Cellulitis of other sites
L03.9	Cellulitis and acute lymphangitis, unspecified
L03.90	Cellulitis, unspecified
L08.9	Local infection of the skin and subcutaneous tissue, unspecified
N48.22	Cellulitis of corpus cavernosum and penis
Syphilis
A50	Congenital syphilis
A50.0	Early congenital syphilis, symptomatic
A50.01	Early congenital syphilitic oculopathy
A50.02	Early congenital syphilitic osteochondropathy
A50.03	Early congenital syphilitic pharyngitis
A50.04	Early congenital syphilitic pneumonia
A50.05	Early congenital syphilitic rhinitis
A50.06	Early cutaneous congenital syphilis
A50.07	Early mucocutaneous congenital syphilis
A50.08	Early visceral congenital syphilis
A50.09	Other early congenital syphilis, symptomatic
A50.1	Early congenital syphilis, latent
A50.2	Early congenital syphilis, unspecified
A50.3	Late congenital syphilitic oculopathy
A50.30	Late congenital syphilitic oculopathy, unspecified
A50.31	Late congenital syphilitic interstitial keratitis
A50.32	Late congenital syphilitic chorioretinitis
A50.39	Other late congenital syphilitic oculopathy
A50.4	Late congenital neurosyphilis [juvenile neurosyphilis]
A50.40	Late congenital neurosyphilis, unspecified
A50.41	Late congenital syphilitic meningitis
A50.42	Late congenital syphilitic encephalitis
A50.43	Late congenital syphilitic polyneuropathy
A50.44	Late congenital syphilitic optic nerve atrophy
A50.45	Juvenile general paresis
A50.49	Other late congenital neurosyphilis
A50.5	Other late congenital syphilis, symptomatic
A50.51	Clutton's joints
A50.52	Hutchinson's teeth
A50.53	Hutchinson's triad
A50.54	Late congenital cardiovascular syphilis
A50.55	Late congenital syphilitic arthropathy
A50.56	Late congenital syphilitic osteochondropathy
A50.57	Syphilitic saddle nose
A50.59	Other late congenital syphilis, symptomatic
A50.6	Late congenital syphilis, latent
A50.7	Late congenital syphilis, unspecified
A50.9	Congenital syphilis, unspecified
A51	Early syphilis
A51.0	Primary genital syphilis
A51.1	Primary anal syphilis
A51.2	Primary syphilis of other sites
A51.3	Secondary syphilis of skin and mucous membranes
A51.31	Condyloma latum
A51.32	Syphilitic alopecia
A51.39	Other secondary syphilis of skin
A51.4	Other secondary syphilis
A51.41	Secondary syphilitic meningitis
A51.42	Secondary syphilitic female pelvic disease
A51.43	Secondary syphilitic oculopathy
A51.44	Secondary syphilitic nephritis
A51.45	Secondary syphilitic hepatitis
A51.46	Secondary syphilitic osteopathy
A51.49	Other secondary syphilitic conditions
A51.5	Early syphilis, latent
A51.9	Early syphilis, unspecified
A52	Late syphilis
A52.0	Cardiovascular and cerebrovascular syphilis
A52.00	Cardiovascular syphilis, unspecified
A52.01	Syphilitic aneurysm of aorta
A52.02	Syphilitic aortitis
A52.03	Syphilitic endocarditis
A52.04	Syphilitic cerebral arteritis
A52.05	Other cerebrovascular syphilis
A52.06	Other syphilitic heart involvement
A52.09	Other cardiovascular syphilis
A52.1	Symptomatic neurosyphilis
A52.10	Symptomatic neurosyphilis, unspecified
A52.11	Tabes dorsalis
A52.12	Other cerebrospinal syphilis
A52.13	Late syphilitic meningitis
A52.14	Late syphilitic encephalitis
A52.15	Late syphilitic neuropathy
A52.16	Charcot's arthropathy (tabetic)
A52.17	General paresis
A52.19	Other symptomatic neurosyphilis
A52.2	Asymptomatic neurosyphilis
A52.3	Neurosyphilis, unspecified
A52.7	Other symptomatic late syphilis
A52.71	Late syphilitic oculopathy
A52.72	Syphilis of lung and bronchus
A52.73	Symptomatic late syphilis of other respiratory organs
A52.74	Syphilis of liver and other viscera
A52.75	Syphilis of kidney and ureter
A52.76	Other genitourinary symptomatic late syphilis
A52.77	Syphilis of bone and joint
A52.78	Syphilis of other musculoskeletal tissue
A52.79	Other symptomatic late syphilis
A52.8	Late syphilis, latent
A52.9	Late syphilis, unspecified
A53	Other and unspecified syphilis
A53.0	Latent syphilis, unspecified as early or late
A53.9	Syphilis, unspecified
A65	Nonvenereal syphilis
O98.1	Syphilis complicating pregnancy, childbirth and the puerperium
O98.11	Syphilis complicating pregnancy
O98.111	Syphilis complicating pregnancy, first trimester
O98.112	Syphilis complicating pregnancy, second trimester
O98.113	Syphilis complicating pregnancy, third trimester
O98.119	Syphilis complicating pregnancy, unspecified trimester
O98.12	Syphilis complicating childbirth
O98.13	Syphilis complicating the puerperium
Trachoma
A71	Trachoma
A71.0	Initial stage of trachoma
A71.1	Active stage of trachoma
A71.9	Trachoma, unspecified
Tularemia
A21	Tularemia
A21.0	Ulceroglandular tularemia
A21.1	Oculoglandular tularemia
A21.2	Pulmonary tularemia
A21.3	Gastrointestinal tularemia
A21.7	Generalized tularemia
A21.8	Other forms of tularemia
A21.9	Tularemia, unspecified
Typhus infections
A75	Typhus fever
A75.0	Epidemic louse-borne typhus fever due to rickettsia prowazekii
A75.1	Recrudescent typhus [brill's disease]
A75.2	Typhus fever due to rickettsia typhi
A75.3	Typhus fever due to rickettsia tsutsugamushi
A75.9	Typhus fever, unspecified
Upper respiratory pneumococcal infection
B95.3	Streptococcus pneumoniae as the cause of diseases classified elsewhere
J00	Acute nasopharyngitis [common cold]
J01	Acute sinusitis
J01.0	Acute maxillary sinusitis
J01.00	Acute maxillary sinusitis, unspecified
J01.01	Acute recurrent maxillary sinusitis
J01.1	Acute frontal sinusitis
J01.10	Acute frontal sinusitis, unspecified
J01.11	Acute recurrent frontal sinusitis
J01.2	Acute ethmoidal sinusitis
J01.20	Acute ethmoidal sinusitis, unspecified
J01.21	Acute recurrent ethmoidal sinusitis
J01.3	Acute sphenoidal sinusitis
J01.30	Acute sphenoidal sinusitis, unspecified
J01.31	Acute recurrent sphenoidal sinusitis
J01.4	Acute pansinusitis
J01.40	Acute pansinusitis, unspecified
J01.41	Acute recurrent pansinusitis
J01.8	Other acute sinusitis
J01.80	Other acute sinusitis
J01.81	Other acute recurrent sinusitis
J01.9	Acute sinusitis, unspecified
J01.90	Acute sinusitis, unspecified
J01.91	Acute recurrent sinusitis, unspecified
J02	Acute pharyngitis
J02.0	Streptococcal pharyngitis
J02.9	Acute pharyngitis, unspecified
J03	Acute tonsillitis
J03.0	Streptococcal tonsillitis
J03.00	Acute streptococcal tonsillitis, unspecified
J03.01	Acute recurrent streptococcal tonsillitis
J03.9	Acute tonsillitis, unspecified
J03.90	Acute tonsillitis, unspecified
J03.91	Acute recurrent tonsillitis, unspecified
J04	Acute laryngitis and tracheitis
J04.0	Acute laryngitis
J04.1	Acute tracheitis
J04.10	Acute tracheitis without obstruction
J04.11	Acute tracheitis with obstruction
J04.2	Acute laryngotracheitis
J04.3	Supraglottitis, unspecified
J04.30	Supraglottitis, unspecified, without obstruction
J04.31	Supraglottitis, unspecified, with obstruction
J05	Acute obstructive laryngitis [croup] and epiglottitis
J05.0	Acute obstructive laryngitis [croup]
J05.1	Acute epiglottitis
J05.10	Acute epiglottitis without obstruction
J05.11	Acute epiglottitis with obstruction
J06	Acute upper respiratory infections of multiple and unspecified sites
J06.0	Acute laryngopharyngitis
J06.9	Acute upper respiratory infection, unspecified
Ureaplasma urealyticum infection
B96.89	Other specified bacterial agents as the cause of diseases classified elsewhere
Yaws
A66	Yaws
A66.0	Initial lesions of yaws
A66.1	Multiple papillomata and wet crab yaws
A66.2	Other early skin lesions of yaws
A66.3	Hyperkeratosis of yaws
A66.4	Gummata and ulcers of yaws
A66.5	Gangosa
A66.6	Bone and joint lesions of yaws
A66.7	Other manifestations of yaws
A66.8	Latent yaws
A66.9	Yaws, unspecified