Doxycycline: Are its 'side-effects' a contra-indication to its use?

Abstract

Objectives: To briefly outline the development and reasons for the decline in the clinical use of tetracyclines, and to consider if the side-effects of doxycycline a contra-indication to its use. Data Sources: Literature search of MEDLINE from 1950 to 2005. Study Selection: Literature and data related to doxycycline, tetracycline and tooth discolouration. Data Extraction: Relevant information and data were reviewed by the authors. Data Synthesis: The established side-effect of tooth discolouration has led to the formation of guidelines to restrict the use of the tetracyclines in susceptible groups of patients, such as pregnant women and throughout childhood. The severity of the discolouration is likely to be related to the different homologues of the tetracyclines, dose, frequency, the stage of odontogenesis, and the duration of the therapy. The majority of published clinical data indicates that doxycycline can be prescribed for children because it causes the least severe type of tooth discolouration. However, there has not been a prospective, randomised, double blind study that compared doxycycline with other tetracyclines to make a definitive statement about the decreased incidence of dental discolouration by doxycycline. The propriety of carrying out a clinical trial using doxycycline involving children when the side-effects of tetracyclines are already well known is also disputable. Conclusions: Caution should be exercised when prescribing doxycycline to children who should be kept under long term review because of the insufficient data concerning the discolouration of the developing teeth.