{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:49:57Z","timestamp":1791838197987,"version":"4.3.4"},"reference-count":63,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,2,18]],"date-time":"2022-02-18T00:00:00Z","timestamp":1645142400000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Early Researcher Award from the Government of Ontario"},{"name":"Tier 2 Canada Research Chair in HIV Prevention and STI Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>There is interest in doxycycline as prophylaxis against sexually transmitted infections (STIs), but concern about antimicrobial resistance (AMR). We conducted a systematic review (CRD42021273301) of the impact of oral tetracycline-class antibiotics on AMR in normal flora.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We searched MEDLINE, EMBASE, the Cochrane Library (1940\u20132021) and conference proceedings (2014\u201321) for randomized controlled trials in adults comparing daily oral tetracycline-class antibiotics to non-tetracycline controls. The primary outcome was AMR to tetracyclines; secondary outcomes included resistance to non-tetracyclines. Data were inappropriate for meta-analysis, so we analysed findings descriptively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Our search yielded 6265 abstracts of which 7 articles fulfilled inclusion criteria. Most were at moderate\/high risk of bias, generally due to inadequate methodologic reporting. Studies used doxycycline, tetracycline, oxytetracycline or minocycline for 2\u201318\u2005weeks. Most observed an increased burden of tetracycline resistance, including in subgingival (n\u200a=\u200a3 studies), gastrointestinal (n\u200a=\u200a2) and upper respiratory tract (n\u200a=\u200a1) flora; one study of skin flora found no change in tetracycline-resistant Propionibacterium species after 18\u2005weeks of oxytetracycline\/minocycline. Four studies reassessed AMR at 2\u201350\u2005weeks post-intervention and reported varying degrees of resistance. Three articles reported on the prevalence of non-tetracycline AMR after doxycycline prophylaxis, of which one found a transient increase among gastrointestinal Escherichia coli; the other two showed no difference from control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although the effects are modest and transient, limited data from small prospective studies may suggest that oral tetracyclines for 2\u201318\u2005weeks increase resistance in subgingival, gastrointestinal and upper respiratory tract flora. STI prophylaxis trials should include AMR in commensal bacteria as study outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlac009","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T12:09:13Z","timestamp":1643285353000},"source":"Crossref","is-referenced-by-count":62,"title":["A systematic review of the impacts of oral tetracycline class antibiotics on antimicrobial resistance in normal human flora"],"prefix":"10.1093","volume":"4","author":[{"given":"Robinson","family":"Truong","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Toronto, 1 King\u2019s College Cir, Toronto, ON M5S 1A8, Canada"},{"name":"Centre for Urban Health Solutions, St. Michael\u2019s Hospital, 209 Victoria St, Toronto, ON M5B 1T8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Tang","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Toronto, 1 King\u2019s College Cir, Toronto, ON M5S 1A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Grennan","sequence":"additional","affiliation":[{"name":"BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada"},{"name":"Division of Infectious Diseases and Department of Medicine, University of British Columbia, 317\u20132194 Health Sciences Mall, Vancouver, BC V6\u2005T 1Z3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3069-2875","authenticated-orcid":false,"given":"Darrell H. 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