Minocycline (MINO), a tetracycline antibiotic, has been available since the 1960s. The intravenous (IV) formulation was withdrawn from the market in 2005 but was reintroduced in the US market in 2009. The drug has potent activity against methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative organisms (MDRO), specifically Acinetobacter baumannii, extended-spectrum β-lactamase (ESBL), and Klebsiella pneumoniae carbapenemase-producing Klebsiella and Escherichia coli species. We used IV MINO in various clinical situations, where there were few or no other options for treatment.
All cases treated with IV MINO from 2009 to 2012 were reviewed. Data were collected for demographics, reasons for IV MINO use, and outcome.
Twenty-one patients were treated with IV MINO; 12 patients had MRSA infections, 3 patients had mixed MRSA and gram-negative infections, and 8 patients had MDRO infections. There were 8 patients with bacteremia, 5 patients with pneumonia, 8 patients with skin and soft tissue infections, one patient each with endocarditis and osteomyelitis, and 2 patients had urinary tract infection. Twelve patients continued treatment with oral MINO. Twenty patients were discharged, and one patient died.
Intravenous MINO is an excellent treatment option for certain MRSA and MDRO infections, where there is a paucity of treatment options. The drug has a favorable pharmacokinetic profile and allows for completion of treatment with an oral formulation.