tetracycline hydrochloride Nursing Considerations & Management

 Drug Name

Generic Name : tetracycline hydrochloride

Brand Name:  Apo-Tetra (CAN), Nu-Tetra (CAN), Sumycin

Classification: Antibiotic, Tetracycline

Pregnancy Category D

Dosage & Route

Available forms : Capsules—250, 500 mg; oral suspension—125 mg/5 mL


Systemic administration

1–2 g/day PO in two to four equal doses. Up to 500 mg PO qid.

  • Brucellosis: 500 mg PO qid for 3 wk with 1 g streptomycin bid IM the first week and daily the second wk.
  • Syphilis: 30–40 g PO in divided doses over 10–15 days (Sumycin); 500 mg PO qid for 15–30 days (all others).
  • Uncomplicated gonorrhea: 1.5 g initially, then 500 mg q 6 hr PO to a total of 9 g.
  • Gonococcal urethritis: 1.5 g PO initially, then 500 mg q 4–6 hr for 4–6 days.
  • Uncomplicated urethral, endocervical, or rectal infections with chlamydia trachomatis: 500 mg qid PO for at least 7 days.
  • Severe acne: 1 g/day PO in divided doses; then 125–500 mg/day.


  • 25–50 mg/kg/day PO in four equal doses.
Therapeutic actions
  • Tetracycline exhibits its bacteriostatic action by reversible binding to the 30s subunits of the ribosome thus preventing protein synthesis and arresting cell growth. It has a broad spectrum of antimicrobial activity including Chlamydiaceae, Mycoplasma spp., Rickettsia spp., spirochetes, many aerobic and anaerobic Gram-positive and Gram-negative pathogenic bacteria, and some protozoa.
Systemic administration
  • Infections caused by rickettsiae; Mycoplasma pneumoniae; agents of psittacosis, ornithosis, lymphogranuloma venereum and granuloma inguinale; Borrelia recurrentis, Haemophilus ducreyi, Yersinia pestis, Yersinia tularensis, Bartonella bacilliformis, Bacteroides, Vibrio cholerae, Campylobacter fetus, Brucella, Escherichia coli, Enterobacter aerogenes, Shigella, Acinetobacter calcoaceticus, Haemophilus influenzae, Klebsiella, trachoma
  • When penicillin is contraindicated, infections caused by Neisseria gonorrhoeae, Treponema pallidum, Treponema pertenue, Listeria monocytogenes, Clostridium, Bacillus anthracis, Fusobacterium fusiforme, Actinomyces
  • Adjunct to amebicides in acute intestinal amebiasis
  • Uncomplicated urethral, endocervical or rectal infections in adults caused by Chlamydia trachomatis
  • Adjunctive therapy for severe acne
Adverse effects
  • Esophageal ulceration, nausea, vomiting, oral candidiasis, diarrhea, epigastric burning, sore throat, black hairy tongue, pancreatitis, oncholysis, discoloration of tooth (children with developing teeth) and nails, tinnitus, visual disturbances, superinfections, photosensitivity, hypersensitivity,
  • Potentially Fatal: Anaphylaxis, hepatotoxicity, nephrotoxicity, blood dyscrasias.
  • Hypersensitivity; pregnancy, lactation, children; renal impairment.
Nursing considerations
  • History: Systemic administration and dermatologic solutions: Allergy to any of the tetracyclines; hepatic or renal impairment, pregnancy, lactation.
  • Physical: Systemic administration, topical dermatologic solutions: Site of infection, skin color, lesions; R, adventitious sounds; bowel sounds, output, liver evaluation; urinalysis, BUN, LFTs, renal function tests. Dermatologic ointment: Site of infection.
  • Administer oral medication on an empty stomach, 1 hr before or 2–3 hr after meals. Do not give with antacids. If antacids must be used, give them 3 hr after the dose of tetracycline.
  • Culture infection before beginning drug therapy; many resistant strains have been identified.
  • Do not administer during pregnancy; drug is toxic to the fetus.
  • WARNING: Do not use outdated drugs; degraded drug is highly nephrotoxic and should not be used.
  • Arrange for regular renal function tests with long-term therapy.
Teaching points
  • Take the drug throughout the day for best results. The drug should be taken on an empty stomach, 1 hour before or 2–3 hours after meals, with a full glass of water. Do not take the drug with food, dairy products, iron preparations, or antacids.
  • Finish your complete prescription; if any is left, discard it immediately. Never take an outdated tetracycline product.
  • There have been reports of pregnancy occurring when taking tetracycline with hormonal contraceptives. To be certain of avoiding pregnancy, use an additional type of contraceptive.
  • This drug should not be used during pregnancy; using barrier contraceptives is advised.
  • You may experience these side effects: Stomach upset, nausea (reversible); superinfections in the mouth, vagina (frequent washing may help this problem; if severe, request medication); sensitivity of the skin to sunlight (use protective clothing and a sunscreen).
  • Report severe cramps, watery diarrhea, rash or itching, difficulty breathing, dark urine or light-colored stools, yellowing of the skin or eyes.