Tetracyclines, the old and the new: A narrative review

Abstract Background Tetracyclines have remained a cornerstone of antimicrobial therapy for over seven decades, demonstrating broad-spectrum activity against a wide range of pathogens, including gram-positive, gram-negative, and atypical bacteria. Objectives This narrative review explores the pharmacological properties, clinical uses, and challenges associated with tetracycline antimicrobials, highlighting their enduring significance in medicine today. Sources A literature review was performed in PubMed using terms related to tetracyclines and their derivatives. Prescribing material for each of the included medications was also reviewed. Content This review will specifically cover tetracycline, doxycycline, minocycline, tigecycline, eravacycline, and omadacycline. Implications Tetracyclines have been pivotal in treating various infections since their discovery in the 1940s, from common conditions like acne to emerging infections like nontuberculous mycobacterial disease. The development of newer tetracycline derivatives has enhanced their activity and expanded their clinical applications.