Clinical practice guideline for the use of new-generation tetracycline-class antibiotics in pediatrics (2026 edition)

The first-generation tetracyclines were natural products derived from microbial metabolism and approved for the treatment of various bacterial infections. After being widely used in clinical treatment, tetracyclines were found to cause adverse effects such as permanent tooth discoloration and enamel hypoplasia in children<8 years of age. Consequently, for more than half a century, warnings related to tooth discoloration have been included in the labels of all tetracycline-class agents, and they are not recommended for use in children under 8 years of age. Subsequently, the second-generation and third-generation tetracyclines (doxycycline, minocycline, tigecycline) are not recommended for use in children below 8 years of age. The new-generation tetracycline-class antibacterials play an important role in treating infections caused by various special pathogens and drug-resistant bacteria. In recent years, as the clinical demand for using new new-generation tetracyclines for the treatment of pediatric infectious diseases has been increasing, the clinical indications and safety have become issues of concern. A guideline development group composed of experts in pediatric infection and respiratory specialties, clinical pharmacy and guideline methodologist jointly conducted a comprehensive evidence-based research on the clinical issues related to the pediatric indications, safety, and effectiveness of the three new-generation tetracyclines (doxycycline, minocycline, tigecycline) that have been approved for domestic market and recommended for use in children, aiming to provide guidance for rational drug use in pediatrics in China and to address the practical challenges of off-label drug use.