Other antibiotics include oxytetracycline, doxycycline and erythromycin. Doxycycline is the drug of choice in patients with renal failure or transplanted patients treated with cyclosporin, where erythromycin or minocycline are inappropriate. Trimethoprim is a folic acid antagonist, and is teratogenic, potentially fertile women must be adequately protected against pregnancy. Long term use of trimethoprim may lead to folic acid deficiency, and increase risk of homocysteinaemia in predisposed individuals. The choice of drug depends on disease severity, age, risk of pregnancy as well as cost.
Drug resistance is frequent with tetracycline, erythromycin and trimethoprim.
All drugs carry a risk of side effects, nausea, vomiting, diarrhoea, headache, and drug rash are common to all. Tetracyclines rarely cause liver disease, it is not necessary to do regular liver function tests, unless there is a history of previous liver disease or if the patient has high alcohol intake. Very rare complications of minocycline include a lupus-like hypersensitivity syndrome and arthralgia. If minocycline is taken for over 12 months, liver function should be checked. Doxycycline especially in high dosage leads to photosensitivity.