Minocycline Hydrochloride and Roflumilast

• Generic Name: minocycline
• Dosage Forms: n.a.
• Other Brand Names: Dynacin, Minocin, Minocin PAC, Minolira, Solodyn, Ximino, Vectrin, Myrac

Treatment of respiratory tract infections caused by Mycoplasma pneumoniae.

Treatment of respiratory tract infections caused by Haemophilus influenzae, Streptococcus pneumoniae, or Klebsiella. Should only be used for treatment of infections caused by these bacteria when in vitro susceptibility tests indicate the organism is susceptible.

Acinetobacter Infections

Alternative to imipenem or meropenem for treatment of infections caused by Acinetobacter.

Acne

Adjunctive treatment of moderate to severe inflammatory acne. Not indicated for treatment of noninflammatory acne.

Actinomycosis

Treatment of actinomycosis caused by Actinomyces israelii; oral tetracyclines (usually doxycycline or tetracycline) used as follow-up after initial parenteral penicillin G.

Amebiasis

Adjunct to amebicides for treatment of acute intestinal amebiasis. Tetracyclines not included in current recommendations for treatment of amebiasis caused by Entamoeba.

Anthrax

Alternative to doxycycline for postexposure prophylaxis to reduce the incidence or progression of disease following a suspected or confirmed exposure to aerosolized Bacillus anthracis spores (inhalational anthrax). Initial drug of choice for such prophylaxis is ciprofloxacin or doxycycline; doxycycline is the preferred tetracycline because of ease of administration and proven efficacy in monkey studies.

Alternative to doxycycline for treatment of inhalational anthrax when a parenteral regimen is not available (e.g., supply or logistic problems because large numbers of individuals require treatment in a mass casualty setting). A multiple-drug parenteral regimen (ciprofloxacin or doxycycline and 1 or 2 other anti-infectives predicted to be effective) is preferred for treatment of inhalational anthrax that occurs as the result of exposure to anthrax spores in the context of biologic warfare or bioterrorism.

Bartonella Infections

Treatment of bartonellosis caused by Bartonella bacilliformis.

Brucellosis

Treatment of brucellosis; tetracyclines (usually doxycycline or tetracycline) considered drugs of choice. Tetracyclines used in conjunction with other anti-infectives (e.g., streptomycin or gentamicin and/or rifampin), especially for severe infections or when there are complications (e.g., endocarditis, meningitis, osteomyelitis).

Campylobacter Infections

Treatment of infections caused by Campylobacter. Tetracyclines (usually doxycycline) are alternatives, not drugs of choice for C. jejuni.

Chancroid

Treatment of chancroid caused by Haemophilus ducreyi. Not included in CDC recommendations for treatment of chancroid.

Chlamydial Infections

Treatment of uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis. Doxycycline is the preferred tetracycline for treatment of these infections, including presumptive treatment of chlamydial infections in patients with gonorrhea.

Treatment of trachoma and inclusion conjunctivitis caused by C. trachomatis. Consider that anti-infectives may not eliminate C. trachomatis in all cases of chronic trachoma.

Treatment of lymphogranuloma venereum (genital, inguinal, or anorectal infections) caused by C. trachomatis. Doxycycline is the preferred tetracycline for these infections.

Treatment of psittacosis (ornithosis) caused by C. psittaci. Doxycycline and tetracycline are drugs of choice. For initial treatment of severely ill patients, use IV doxycycline.

Clostridium Infections

Alternative for treatment of infections caused by Clostridium. Tetracyclines are alternatives to metronidazole or penicillin G for adjunctive treatment of C. tetani infections.

Enterobacteriaceae Infections

Treatment of infections caused by susceptible Escherichia coli, Enterobacter aerogenes, Klebsiella, or Shigella. Should only be used for treatment of infections caused by these common gram-negative bacteria when other appropriate anti-infectives are contraindicated or ineffective and when in vitro susceptibility tests indicate the organism is susceptible.

Fusobacterium Infections

Alternative to penicillin G for treatment of infections caused by Fusobacterium fusiforme (Vincent’s infection).

Gonorrhea and Associated Infections

Alternative for treatment of uncomplicated gonorrhea (including urethritis) caused by susceptible Neisseria gonorrhoeae. Tetracyclines are considered inadequate therapy and are not recommended by CDC for treatment of gonorrhea.

Granuloma Inguinale (Donovanosis)

Treatment of granuloma inguinale (donovanosis) caused by Calymmatobacterium granulomatis. Doxycycline is the tetracycline recommended as drug of choice by CDC.

Listeria Infections

Alternative for treatment of listeriosis caused by Listeria monocytogenes. Not usually considered a drug of choice or alternative for these infections.

Malaria

Other tetracyclines (doxycycline) used for prevention of malaria; data insufficient to evaluate efficacy of minocycline for malaria prevention. CDC recommends that individuals receiving long-term minocycline therapy (e.g., for acne) who also require doxycycline malaria prophylaxis should discontinue minocycline 1–2 days prior to travel and initiate doxycycline for such prophylaxis; minocycline can be reinitiated after doxycycline malaria prophylaxis is finished.

Mycobacterial Infections

Alternative for use in multiple-drug regimens for treatment of multibacillary leprosy. WHO recommends minocycline as an alternative for multibacillary leprosy regimens in patients who will not accept or cannot tolerate clofazimine and when rifampin cannot be used because of adverse effects, intercurrent disease (e.g., chronic hepatitis), or infection with rifampin-resistant Mycobacterium leprae.

Component of a single-dose rifampin-based multiple-drug regimen (ROM) for treatment of single-lesion paucibacillary leprosy (i.e., a single skin lesion with definite loss of sensation but without nerve trunk involvement). A ROM regimen of a single dose of rifampin, single dose of ofloxacin, and single dose of minocycline is recommended by WHO as an acceptable and cost-effective alternative regimen in antileprosy programs that have detected a large number of patients (e.g., more than 1000 annually) with single-lesion paucibacillary leprosy.

Treatment of cutaneous infections caused by M. marinum; a drug of choice.

Neisseria meningitidis Infections

Elimination of nasopharyngeal carriage of Neisseria meningitidis. CDC and AAP recommend use of rifampin, ceftriaxone, or ciprofloxacin for such carriers and no longer recommend use of minocycline.

Should not be used for treatment of infections caused by N. meningitidis.

Nocardiosis

Tetracyclines are alternative to co-trimoxazole for treatment of nocardiosis caused by Nocardia.

Nongonococcal Urethritis

Treatment of nongonococcal urethritis (NGU) caused by Ureaplasma urealyticum, C. trachomatis, or Mycoplasma. Doxycycline usually is the tetracycline of choice for NGU.

Consider that some cases of recurrent urethritis following treatment may be caused by tetracycline-resistant U. urealyticum.

Plague

Treatment of plague caused by Yersinia pestis. Regimen of choice is streptomycin or gentamicin; alternatives are doxycycline, tetracycline, ciprofloxacin, or chloramphenicol.

Relapsing Fever

Treatment of relapsing fever caused by Borrelia recurrentis. Tetracyclines are drugs of choice.

Rheumatoid Arthritis

Treatment of rheumatoid arthritis. One of several disease-modifying antirheumatic drugs (DMARDs) that can be used when DMARD therapy is appropriate.

Rickettsial Infections

Treatment of rickettsial infections including Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae. Doxycycline is the drug of choice for most rickettsial infections.

Stenotrophomonas maltophilia Infections

Treatment of infections caused by Stenotrophomonas maltophilia. Alternative to co-trimoxazole.

Syphilis

Alternative to penicillin G for treatment of primary, secondary, latent, or tertiary syphilis (not neurosyphilis) in nonpregnant adults and adolescents hypersensitive to penicillins. Doxycycline and tetracycline are the preferred tetracyclines in patients hypersensitive to penicillins. Use tetracyclines only if compliance and follow-up can be ensured since efficacy not well documented.

Tularemia

Treatment of tularemia caused by Francisella tularensis. Tetracyclines (usually doxycycline) considered alternatives to streptomycin (or gentamicin); risk of relapse and primary treatment failure may be higher than with aminoglycosides.

Vibrio Infections

Treatment of cholera caused by Vibrio cholerae. Doxycycline and tetracycline are drugs of choice; used as an adjunct to fluid and electrolyte replacement in moderate to severe disease.

Yaws

Alternative to penicillin G for treatment of yaws caused by Treponema pertenue.

• Generic Name: roflumilast
• Dosage Forms: n.a.
• Other Brand Names: Daliresp

Roflumilast reduces inflammation in the lungs that leads to COPD (chronic obstructive pulmonary disease).

Roflumilast is used to prevent worsening of symptoms in people with severe COPD.

Roflumilast is not a bronchodilator and will not treat a bronchospasm attack that has already begun.

Roflumilast may also be used for purposes not listed in this medication guide.