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CLINICAL REVIEW: J Lochhead and J S Elston Lesson of the week: Doxycycline induced intracranial hypertension BMJ 2003; 326: 641-642 [Full text]

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Nalidixic acid major culprit in children in eastern India

Dhiraj Ahlawat   (24 March 2003)

Doxycycline, dentists and adverse effects

Trevor LP Watts   (13 June 2003)

Nalidixic acid major culprit in children in eastern India 24 March 2003
Dhiraj Ahlawat, Pediatrician Ghaziabad-201 001, India Send response to journal: Re: Nalidixic acid major culprit in children in eastern India	I had seen a large number of children with benign intracranial hypertension due to indiscriminate prescription of nalidixic acid during my training in Pediatrics at Varanasi, India. Others also have had a similar experience in that region of the country. Nalidixic acid was the most common antibiotic prescribed for diarrhea by physicians outside the teaching institution. Though many would respond to diagnostic lumbar puncture, some also required admission for decongestive therapy to reduce raised intracranial pressure. As many patients are lost to follow-up in India, it's impossible to even guess how many of them would have progressed to visual loss. Competing interests:   None declared
Doxycycline, dentists and adverse effects 13 June 2003
Trevor LP Watts, Head of Department of Periodontology and Preventive Dentistry Guy's, King's and St Thomas' Dental Institute, London Bridge, SE1 9RT, UK Send response to journal: Re: Doxycycline, dentists and adverse effects	Medical practitioners may not be aware that dentists prescribe tetracyclines for periodontal problems. For convenience and compliance, doxycycline is often used. The drug may be used in a 2-week course as an adjunct to non-surgical treatment for early- onset forms of periodontitis (1,2). However, a recent development has been the marketing of a doxycycline preparation intended for long-term periodontal use in a daily dose of 20 mg, as a protease inhibitor and not as an antibiotic. This preparation has been widely promoted, and many patients may be taking it. It supposedly has no effects on microbial resistance, though the published studies are limited (3). In respect of the report of Lochhead and Elston (4), I have seen someone who developed a marked diplopia on the 4th day of a doxycycline course at 100 mg per day. This resolved on cessation of the drug. Medical practitioners need to be aware that patients presenting with eye symptoms or headaches may be the recipients of doxycycline or other tetracyclines prescribed by their dental practitioners, and should be specifically asked about this. Some patients may not be aware of what they are taking, and I have just written to the British Dental Journal to alert dentists to the matter. (1) Palmer RM, Watts TLP, Wilson RF. A double-blind trial of tetracycline in the management of early-onset periodontitis. J Clin Periodontol 1996; 23: 670- 67. (2) Watts TLP. Periodontitis for medical practitioners. BMJ 1998; 316: 993-99. (3) Thomas J, Walker C, Bradshaw M. Long-term use of subantimicrobial dose doxycycline does not lead to changes in antimicrobial susceptibility. J Periodontol 2000; 71: 1472-83. (4) Lochhead J, Elston JS. Lesson of the week: doxycycline induced intracranial hypertension. BMJ 2003; 326: 641-42. Competing interests:   None declared