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Minocycline Indications & Clinical Uses

Evidence-based guide for pediatric prescribing

Minocycline is a lipophilic tetracycline used primarily for inflammatory acne and certain resistant gram-positive infections when other agents are unsuitable.

Primary FDA-Approved Indications

Reserve minocycline for adolescents requiring systemic acne therapy or culture-proven infections responsive to tetracyclines. Consider antimicrobial stewardship—many infections have safer or narrower alternatives.

Moderate to severe inflammatory acne vulgaris

FDA Approved
Adolescents ≥12 yearsHighFirst-line

Always combine with topical benzoyl peroxide/retinoid to reduce resistance; reassess need every 3 months.

Evidence Sources

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Secondary Clinical Uses

Community-acquired MRSA skin and soft-tissue infection (when clindamycin resistance or allergy is present)

Secondary Use
Children ≥8 years and adolescentsModerate

Avoid in children <8 due to tooth discoloration; perform incision and drainage for abscesses.

Evidence Sources

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Off-Label Uses

Note: Off-label uses may be clinically appropriate based on evidence and expert consensus, but are not FDA-approved for these indications. Always consider the evidence base and document clinical reasoning.

Mycoplasma pneumoniae infection (beta-lactam macrolide-resistant)

Off-Label
Children ≥8 years

Consult infectious disease; minocycline is occasionally used when macrolide resistance documented and doxycycline unavailable.

Evidence Sources

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•Evidence quality: 80/10
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