A new study published in the Journal of Neuro-Ophthalmology evaluated whether the use of a tetracycline-class antibiotic is associated with an increased risk of developing pseudotumor cerebri syndrome (PTCS).
The study details
Between 2007 and 2014, the research team identified 960 patients between the ages of 12 and 50 years who were prescribed tetracycline antibiotics. Among them, 45 were diagnosed with tetracycline-induced PTCS. The researchers estimated the incidence of tetracycline-induced PTCS to be 63.9 per 100,000 person-years. By comparison, the incidence of idiopathic intracranial hypertension (IIH) is estimated to be less than one per 100,000 person-years.
Why would tetracyclines put patients at risk for developing PTCS?
There are a few theories, but it remains poorly understood. Some studies suggest a genetic predisposition to tetracycline-induced PTCS, with possible effects at the arachnoid villi, choroid plexus, or venous capillary bed.
Another theory is that retinol and retinol-binding protein have been implicated in the pathogenesis of IIH, and retinoic acid catabolism is inhibited by minocycline.
The take home
According to the authors, regardless of the underlying pathogenesis of the disease and the contribution of tetracycline antibiotics, the data suggest that the use of these medications puts patients at increased risk for the development of PTCS.