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- Brand: Acme Laboratories Limited
- Product ID: Tetracycline Hydrochloride
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A-Tetra 500mg Capsule — Tetracycline Hydrochloride | Beximco Pharmaceuticals
| Generic Name | Tetracycline Hydrochloride 500mg |
| Drug Class | Broad-Spectrum Tetracycline Antibiotic |
| Manufacturer | Beximco Pharmaceuticals Ltd. |
| Route | Oral (Capsule) |
| Prescription Status | Prescription Required |
Overview
A-Tetra 500mg contains Tetracycline Hydrochloride — a broad-spectrum bacteriostatic antibiotic covering Gram-positive, Gram-negative, and crucially, intracellular organisms (Chlamydia, Mycoplasma, Rickettsia) that beta-lactams and aminoglycosides cannot reach. Despite being an older antibiotic, tetracycline retains important clinical roles: Helicobacter pylori eradication (quadruple therapy), acne vulgaris, chlamydial infections, leptospirosis, cholera, and brucellosis. It is a critical component of bismuth-containing quadruple therapy for H. pylori — particularly important in Bangladesh where H. pylori prevalence is very high and clarithromycin resistance is increasing.
Mechanism of Action
Tetracycline binds reversibly to the 30S bacterial ribosomal subunit (specifically to the 16S rRNA), blocking the aminoacyl-tRNA from docking at the ribosomal A site and inhibiting protein elongation. This is bacteriostatic — it inhibits bacterial growth rather than directly killing organisms, relying on host immune defences for clearance. Tetracycline is actively concentrated inside bacterial cells by an energy-dependent uptake mechanism — this same mechanism (in reverse) underlies resistance, where resistant bacteria pump tetracycline out actively.
Spectrum of Activity
| Category | Organisms |
|---|---|
| Gram-positive | Streptococcus spp., S. pneumoniae (variable resistance), Staphylococcus aureus (variable) |
| Gram-negative | H. pylori, Vibrio cholerae, Haemophilus influenzae, Brucella, Yersinia pestis |
| Intracellular | Chlamydia spp., Mycoplasma pneumoniae, Rickettsia spp., Coxiella burnetii |
| Spirochaetes | Borrelia spp., Leptospira spp. |
| Acne | Cutibacterium acnes (reduced susceptibility with resistance) |
| Not covered | Pseudomonas, MRSA, most Proteus, most Klebsiella (high resistance) |
Indications
- H. pylori eradication — bismuth quadruple therapy (PPI + bismuth + tetracycline + metronidazole) — first-line in areas of high clarithromycin resistance
- Acne vulgaris — moderate-severe (systemic therapy)
- Chlamydial urogenital infections (alternative to doxycycline)
- Community-acquired atypical pneumonia (Mycoplasma, Chlamydia)
- Cholera (Vibrio cholerae) — adjunct to rehydration
- Brucellosis (with streptomycin)
- Leptospirosis (mild cases)
- Rickettsia infections (scrub typhus, spotted fever)
Dosage
| Indication | Dose | Frequency | Duration |
|---|---|---|---|
| H. pylori (quadruple therapy) | 500mg | 4 times daily | 10–14 days (with PPI + bismuth + metronidazole) |
| Acne vulgaris | 500mg | Twice daily (fasting) | 3–6 months (reassess) |
| Chlamydia / atypical infection | 500mg | Every 6 hours | 7–14 days |
| Cholera | 500mg | Every 6 hours | 3 days |
| Brucellosis | 500mg | Every 6 hours | 6 weeks (with streptomycin) |
Must be taken on an empty stomach — at least 1 hour before or 2 hours after meals. Food, dairy products, calcium, iron, magnesium, and antacids reduce absorption by chelation. Do not take with milk.
Critical Diabetic Patient Information
- H. pylori — elevated prevalence in diabetics: Diabetic patients have a higher prevalence of H. pylori infection and associated peptic ulcer disease. Tetracycline-based quadruple therapy is increasingly recommended as first-line in Bangladesh where clarithromycin resistance rates exceed 20%. Successful H. pylori eradication may improve glycaemic control in some patients (elimination of infection-related insulin resistance)
- Antacid timing — critical: Many diabetic patients take calcium supplements, magnesium-containing antacids, or iron tablets. These chelate tetracycline and dramatically reduce its absorption — take A-Tetra at least 2 hours before or after any mineral supplement, antacid, or dairy product
- Renal dosing in diabetic nephropathy: Tetracycline is contraindicated or should be used with extreme caution in significant renal impairment (eGFR <30) — it can accumulate and cause antianabolic effects (increased BUN). Doxycycline is preferred in diabetics with CKD as it is primarily hepatically excreted
- Photosensitivity: Tetracycline causes significant photosensitivity — diabetic patients with neuropathic skin may not notice early sun damage. Use broad-spectrum SPF 50+ sunscreen daily and avoid prolonged sun exposure during treatment
- Acne management in diabetics: Hormonal changes in type 2 diabetes (hyperinsulinaemia, elevated androgens) contribute to acne. Systemic tetracycline for acne in diabetic patients requires monitoring for renal function and avoidance of mineral interactions
Side Effects
| System | Side Effect | Severity |
|---|---|---|
| GI | Nausea, vomiting, diarrhoea, oesophageal irritation (if not taken with adequate water) | Common — Mild to Moderate |
| Skin | Photosensitivity — sunburn-like reaction in sun-exposed areas | Common — use sunscreen |
| Dental | Permanent tooth discolouration and enamel hypoplasia in children <8 years (systemic tetracycline) | Serious — avoid in children <8 years and pregnancy |
| Hepatic | Hepatotoxicity (mainly with IV high-dose — rare with oral standard doses) | Rare with oral use |
| Renal | Antianabolic effect — raises BUN; Fanconi syndrome (with outdated tetracycline) | Moderate in renal impairment |
| CNS | Intracranial hypertension (pseudotumour cerebri) — rare | Rare — headache, visual changes → stop and review |
| Superinfection | Candidal overgrowth (oral/vaginal thrush) from broad-spectrum coverage | Common with prolonged courses |
Drug Interactions
| Drug / Food | Interaction |
|---|---|
| Antacids (Al, Mg, Ca, Bi salts) | Form insoluble chelates — reduce absorption by up to 90%. Take tetracycline 2 hours before or after |
| Dairy products / milk | Calcium chelation — reduce absorption significantly. Take fasting |
| Iron / zinc supplements | Chelation — reduce tetracycline absorption. Separate by 2 hours |
| Warfarin | Tetracycline may enhance anticoagulant effect — monitor INR |
| Oral contraceptives | May reduce OCP efficacy via gut flora suppression — use barrier contraception during treatment |
| Isotretinoin | Additive intracranial hypertension risk — avoid concurrent use |
| Methoxyflurane | Enhanced nephrotoxicity — avoid |
Contraindications
- Pregnancy (all trimesters — causes fetal tooth discolouration and skeletal development issues)
- Children under 8 years (permanent tooth discolouration)
- Renal impairment (eGFR <30) — use doxycycline instead
- Known hypersensitivity to tetracyclines
- Concurrent isotretinoin therapy
Storage
Store below 25°C. Protect from light and moisture. Keep in original packaging. Keep out of reach of children. Do not use after expiry — expired tetracycline can be harmful (degradation products cause Fanconi syndrome).
Frequently Asked Questions
Q: Why must I avoid milk and antacids with A-Tetra?
A: Tetracycline forms insoluble complexes (chelates) with calcium, magnesium, aluminium, and iron ions — dramatically reducing absorption. Always take on an empty stomach with plain water. Even calcium in multivitamins can reduce absorption by 50%.
Q: My H. pylori wasn't treated by previous antibiotics — why is tetracycline used now?
A: Standard triple therapy (clarithromycin + amoxicillin + PPI) has increasing resistance rates in Bangladesh. Bismuth quadruple therapy with tetracycline (which has maintained low resistance rates) is highly effective for resistant H. pylori — cure rates exceed 90% even in clarithromycin-resistant cases.
Q: Can tetracycline be used in diabetics with kidney disease?
A: Standard tetracycline should be avoided in significant CKD (eGFR <30) as it accumulates and has antianabolic effects that raise blood urea. Doxycycline is the preferred tetracycline class antibiotic in CKD. Discuss with your nephrologist.
Medical Disclaimer: A-Tetra 500mg (Tetracycline HCl) is a prescription-only antibiotic. Absolutely contraindicated in pregnancy and children under 8 years. Must be taken fasting — avoid dairy, antacids, iron, and calcium within 2 hours of each dose. Avoid in renal impairment (eGFR <30) — use doxycycline instead. Use sunscreen during treatment. This information is for educational purposes only. Always follow your physician's instructions.
