Lymecycline 408mg capsules

Abstract Background Acne vulgaris is a common dermatological condition affecting a large portion of the population particularly adolescents and young adults. Lymecycline, a tetracycline antibiotic is regularly prescribed in primary care for its treatment. The prescribing of lymecycline, an antibiotic for the treatment of acne vulgaris should be done in accordance with NICE guidelines. Cornwall has amongst the highest prescribing in England with over half of patients receiving treatment for more than 24 weeks, increasing the risk of antimicrobial resistance.1 Objectives Relevant NICE guidance states that patients should be on concurrent topical treatment which is not a topical antibiotic alongside an oral antibiotic (Lymecycline). They should also have 3-month and 6-month reviews to review response to treatment. For women of child-bearing age it is also recommended to be on/ have been offered an effective form of contraception due to the teratogenic effects of tetracycline antibiotics. It also highlights when referral to a specialist should be made/ considered where appropriate. (1) This audit aims to evaluate the surgery’s current prescribing against these NICE criteria when treating and managing acne vulgaris. Methods This is a retrospective review of patient records from a GP surgery in Cornwall, focusing on those diagnosed with acne vulgaris and prescribed an oral antibiotic (lymecycline, minocycline, doxycycline, oxytetracycline and tetracycline) over 4 months in Winter 2024. Data collected included: patient demographics (age, gender), specific antibiotic prescribed, duration of therapy, completion of 3- and 6-month reviews, concurrent topical treatments, contraception use and if there was specialist involvement in the patients care and management. Additionally, compliance with clinical guidelines for antibiotic use in acne treatment was assessed. Results The records of 39 patients were reviewed to assess the adherence to NICE guidelines. Out of the 39 eligible patients, 21 (53.8%) were not prescribed concurrent topical treatment alongside their oral antibiotics. Seventeen (56.7%) of 30 eligible female patients were not prescribed or shown to be offered a form of effective contraception. Regarding the review of the oral antibiotic treatment, 29 (74.4%) of 39 patients had not had their 3-month review with 33 (84.6%) of 39 also not having had their 6-month review, despite still being prescribed regular courses of lymecycline. There was an overall low compliance with the NICE guidelines. Conclusions This audit found significant deviations from the NICE guidelines for acne treatment prescribing. With a substantial proportion of patients not receiving concurrent topical treatments, many women of child-bearing age were not offered effective contraception and majority of patients not undergoing the recommended 3-month and 6-month reviews. Enhanced training for prescribers on appropriate prescribing practices including contraception and systematic review processes, as to limit prescribing to 3-months before prompting a review, may help to address these issues and improve compliance with the guideline standards.

Abstract licence: CC BY 4.0

ImportanceSafety data on tetracycline antibiotic use during pregnancy are limited.ObjectiveTo investigate the association between first trimester exposure to tetracyclines and the risk of major congenital malformations (MCMs).Design, setting, and participantsThis cohort study used data from nationwide registers for singleton infants live-born in Sweden from July 1, 2006, to December 31, 2018, with follow-up through December 2019. Tetracycline-exposed and unexposed infants were matched on propensity scores (ratio 1:10). Data analysis was performed from June 2023 to May 2024.ExposureFirst trimester exposure to tetracyclines determined from maternal prescription fills, compared with no exposure.Main outcomes and measuresThe primary outcome was any MCM diagnosed in the first year of life; secondary outcomes were 12 major malformation organ system subgroups and 16 individual malformations selected on the basis of prior safety signals and/or fulfillment of prespecified statistical power criteria. Malformations were identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes aligned to the European Surveillance of Congenital Anomalies (EUROCAT) classification. Log binomial regression was used to estimate relative risks (RRs) with 95% CIs.ResultsFrom a source cohort of 1 245 889 eligible infants (640 892 male [51.4%]), a propensity score-matched analytical cohort of 69 656 infants (35 903 male [51.5%]) was generated. Of 6340 infants exposed to tetracyclines during the first trimester (3325 male [52.4%]), 252 received a diagnosis of any MCM (39.75 cases per 1000 infants; 95% CI, 35.14-44.93 cases per 1000 infants) compared with 2454 of 63 316 unexposed infants (38.76 cases per 1000 infants; 95% CI, 37.27-40.30 cases per 1000 infants). Tetracycline exposure was not associated with any MCM (RR, 1.03; 95% CI, 0.90-1.16). The RRs for specific tetracycline substances were 1.07 (95% CI, 0.93-1.23) for doxycycline, 0.83 (95% CI, 0.60-1.15) for lymecycline, and 0.78 (95% CI, 0.32-1.92) for tetracycline-oxytetracycline. There was no increased risk for 10 of 12 malformation subgroups or for any of the 16 individual malformations analyzed. The higher RRs in the main analysis for nervous system anomalies (1.92; 95% CI, 0.98-3.78) and eye anomalies (1.76; 95% CI, 1.07-2.91) were attenuated in a sensitivity analysis with follow-up extended to age 3 years (nervous system anomalies, RR, 1.08; 95% CI, 0.52-2.24; eye anomalies, RR, 1.42; 95% CI, 0.88-2.29).Conclusions and relevanceIn this cohort study, first trimester tetracycline exposure was not associated with increased risks of any MCMs. Additional studies are needed to rule out potential risks owing to power limitations for several MCM subgroups and individual malformations.

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Stevens–Johnson syndrome (SJS) and the more severe variant, toxic epidermal necrolysis (TEN), are a spectrum of mucocutaneous reactions with potentially devastating ocular consequences. Ocular complications occur in about 70% of patients with Stevens–Johnson syndrome, and 35% continue with chronic disease. We report an unusual presentation of isolated ocular Stevens–Johnson syndrome in a patient with recently diagnosed ulcerative colitis being treated with Infliximab. The case had an insidious and atypical onset and represented a diagnostic dilemma. The diagnosis was more difficult, due to the fact that the inciting agent had long been stopped. Severe bacterial conjunctivitis such as that caused by Chlamydia Trachomatis, Corynebacterium diphtheria, and Neisseria Gonorrhea can cause forniceal shortening and symblepharon; this diagnosis was ruled out with microbiological swabs. A conjunctival biopsy was the key to diagnosis. Treatment involved high-dose IV steroids and dual immunosuppression with Infliximab and mycophenolate mofetil. We sought to employ interventions with the greatest impacts on our patient’s condition. Our experience contributes to the growing evidence supporting intensive ophthalmic management of SJS to prevent long-term vision loss.

Abstract licence: CC BY 4.0