The
tetracyclines are active in vitro against many urinary tract pathogens such as Chlamydia, Mycoplasma pneumoniae, Brucella, rickettsiae, and Nocardia.
Chloramphenicol is used primarily for anaerobic
infections, Haemophilus influenzae
meningitis, and
infections due to Salmonella typhi.
Erythromycin is active in vitro against M. pneumoniae, Legionella spp., Streptococcus pneumoniae, and group A beta-hemolytic streptococci; it may also be used as prophylactic
therapy for
subacute bacterial endocarditis and for recurrence of
acute rheumatic fever in patients who are allergic to
penicillin.
Clindamycin should be used primarily for the treatment of anaerobic
infections. The
tetracyclines may cause gastrointestinal upset;
phototoxic dermatitis;
hepatitis, especially in pregnant women; discoloration of the teeth and
bone dysplasia in the human fetus and in children; and
superinfections, especially oral and anogenital
candidiasis. The
tetracyclines should be used with caution in patients with
renal insufficiency. The most important toxic effect of
chloramphenicol is bone marrow suppression, which is dose related or idiosyncratic. The incidence of undesirable side effects associated with the use of
erythromycin is low; gastrointestinal irritation is the most common, and cholestatic
hepatitis may occur with the use of
erythromycin estolate.
Pseudomembranous colitis is the most important toxic effect associated with the use of
clindamycin.