Minocycline Applications in Multidrug-Resistant Infections
Summary
Minocycline, a second-generation tetracycline, has re-emerged as a critical agent against multidrug-resistant (MDR) bacterial pathogens. Its high lipophilicity and reliable tissue penetration confer activity against non-fermentative Gram-negative bacilli such as Acinetobacter baumannii and Stenotrophomonas maltophilia, as well as diverse Enterobacterales. Used both as monotherapy and in combination regimens, minocycline demonstrates bacteriostatic and, in certain contexts, bactericidal effects through inhibition of protein synthesis. The revival of minocycline reflects a strategic shift towards repurposing older antibiotics in the face of escalating resistance to carbapenems, polymyxins and newer β-lactam/β-lactamase inhibitor combinations. Clinically, minocycline has been employed for ventilator-associated pneumonia, bloodstream infections and complicated skin and soft tissue infections, often in synergy with colistin, polymyxin B or novel adjuvants. Surveillance studies indicate retained susceptibility among key MDR species, while in vitro pharmacokinetic/pharmacodynamic models and retrospective cohort analyses have elucidated optimal dosing strategies and reduced toxicity when co-administered with nephrotoxic agents. Ongoing research focuses on precision-guided combination therapies, adjuvant molecules to overcome resistance mechanisms and global stewardship frameworks to preserve minocycline’s utility.
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Minocycline Applications in Multidrug-Resistant Infections publication trend
The graph below shows the total number of articles in minocycline applications in multidrug-resistant infections across all publications each year (not limited to Nature Index journals).
Technical terms
Minimum inhibitory concentration (MIC): The lowest antibiotic concentration preventing visible bacterial growth.
Pharmacokinetics/Pharmacodynamics (PK/PD): The relationship between drug concentrations over time and their antimicrobial effect.
Multidrug-resistant (MDR): Bacteria non-susceptible to at least one agent in three or more antimicrobial classes.
Carbapenemase: Enzymes produced by certain bacteria that hydrolyse carbapenem antibiotics, conferring high-level resistance.
Synergy: Enhanced antimicrobial activity observed when two drugs in combination produce a greater effect than the sum of their individual actions.
References
- Activity of polymyxin B combinations against genetically well-characterised Klebsiella pneumoniae producing NDM-1 and OXA-48-like carbapenemases. International Journal of Antimicrobial Agents (2023).
- Trends in the susceptibility of U.S. Acinetobacter baumannii-calcoaceticus species complex and Stenotrophomonas maltophilia isolates to minocycline, 2014–2021. Microbiology Spectrum (2023).
- A Retrospective Cohort Analysis Shows that Coadministration of Minocycline with Colistin in Critically Ill Patients Is Associated with Reduced Frequency of Acute Renal Failure. Antimicrobial Agents and Chemotherapy (2017).
- Polymyxin B Combined with Minocycline: A Potentially Effective Combination against blaOXA-23-harboring CRAB in In Vitro PK/PD Model. Molecules (2022).
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