tetracycline medication.These effects are attributable to direct local irritation of the intestinal tract.Nausea,anorexia,and diarrhea can usually be controlled by administering the drug with food or carboxymethylcellulose,reducing drug dosage,or discontinuing the drug. Tetracyclines modify the normal flora,with suppression of susceptible coliform organisms and overgrowth of pseudomonas,proteus,staphylococci,resistant coliforms,clostridia,and candida.This can result in intestinal functional disturbances, anal pruritus,vaginal or oral candidiasis,or enterocolitis with shock and death. B.BONY STRUCTURES AND TEETH Tetracyclines are readily bound to calcium deposited in newly formed bone or teeth in young children.When a tetracycline is given during pregnancy,it can be deposited in the fetal teeth,leading to fluorescence,discoloration,and enamel dysplasia;it can also be deposited in bone,where it may cause deformity or growth inhibition.If the drug is given for long periods to children under 8 years of age,similar changes can result. C.LIVER TOXICITY Tetracyclines can probably impair hepatic function,especially during pregnancy,in patients with preexisting hepatic insufficiency and when high doses are given intravenously.Hepatic necrosis has been reported with daily doses of 4 g or more intravenously. D.KIDNEY TOXICITY Renal tubular acidosis and other renal injury resulting in nitrogen retention have been attributed to the administration of outdated tetracycline preparations.Tetracyclines given along with diuretics may produce nitrogen retention.Tetracyclines other than doxycycline may accumulate to toxic levels in patients with impaired kidney function. E.LOCAL TISSUE TOXICITY Intravenous injection can lead to venous thrombosis.Intramuscular injection produces painful local irritation and should be avoided. F.PHOTOSENSITIZATION Systemically administered tetracycline,especially demeclocycline,can induce sensitivity to sunlight or ultraviolet light,particularly in fair-skinned persons. G.VESTIBULAR REACTIONS Dizziness,vertigo,nausea,and vomiting have been noted particularly with doxycycline at doses above 100 mg.With dosages of 200-400 mg/d of minocycline, 35-70%of patients will have these reactions. MACROLIDEStetracycline medication. These effects are attributable to direct local irritation of the intestinal tract. Nausea, anorexia, and diarrhea can usually be controlled by administering the drug with food or carboxymethylcellulose, reducing drug dosage, or discontinuing the drug. Tetracyclines modify the normal flora, with suppression of susceptible coliform organisms and overgrowth of pseudomonas, proteus, staphylococci, resistant coliforms, clostridia, and candida. This can result in intestinal functional disturbances, anal pruritus, vaginal or oral candidiasis, or enterocolitis with shock and death. B. BONY STRUCTURES AND TEETH Tetracyclines are readily bound to calcium deposited in newly formed bone or teeth in young children. When a tetracycline is given during pregnancy, it can be deposited in the fetal teeth, leading to fluorescence, discoloration, and enamel dysplasia; it can also be deposited in bone, where it may cause deformity or growth inhibition. If the drug is given for long periods to children under 8 years of age, similar changes can result. C. LIVER TOXICITY Tetracyclines can probably impair hepatic function, especially during pregnancy, in patients with preexisting hepatic insufficiency and when high doses are given intravenously. Hepatic necrosis has been reported with daily doses of 4 g or more intravenously. D. KIDNEY TOXICITY Renal tubular acidosis and other renal injury resulting in nitrogen retention have been attributed to the administration of outdated tetracycline preparations. Tetracyclines given along with diuretics may produce nitrogen retention. Tetracyclines other than doxycycline may accumulate to toxic levels in patients with impaired kidney function. E. LOCAL TISSUE TOXICITY Intravenous injection can lead to venous thrombosis. Intramuscular injection produces painful local irritation and should be avoided. F. PHOTOSENSITIZATION Systemically administered tetracycline, especially demeclocycline, can induce sensitivity to sunlight or ultraviolet light, particularly in fair-skinned persons. G. VESTIBULAR REACTIONS Dizziness, vertigo, nausea, and vomiting have been noted particularly with doxycycline at doses above 100 mg. With dosages of 200-400 mg/d of minocycline, 35-70% of patients will have these reactions. MACROLIDES