La tétracycline, connue sous le nom commercial Sumycin, agit en bloquant la fixation de l’ARNt sur la sous-unité 30S ribosomale, interrompant l’élongation de la chaîne protéique bactérienne. Ce mécanisme confère une activité sur un spectre large, incluant bactéries Gram positives, Gram négatives, rickettsies et spirochètes. Sa biodisponibilité digestive varie selon la prise alimentaire et les interactions avec les ions divalents comme calcium et magnésium. Sa diffusion tissulaire est importante, notamment dans les voies respiratoires et génito-urinaires. L’élimination se fait par voie rénale et biliaire. Les effets indésirables incluent photosensibilisation, troubles digestifs et coloration dentaire en cas d’administration précoce. Les guides thérapeutiques mentionnent sumycin prix, en soulignant la nécessité de restreindre son utilisation afin de limiter les résistances acquises.

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Table 2. Specialized Laboratory Investigation Acute & Chronic Polyneuropathies
Medical Conditions
Laboratory
Connective tissue diseases and vasculitis: Sjogren’s dis-
Antinuclear antigen profile; Rheumatoid factor/RF, anti-Ro/SS- ease; SLE; Rheumatoid; Mixed Connective Tissue Dis- A, anti-La/SS-B (Sjogren’s); Cryoglobulins; Eosinophil count; ease; Polyarteritis Nodosa; Churg-Strauss disease; Complement levels; Anti-neutrophil cytoplasmic antigen anti- Wegener’s granulomatosis; ANCA syndrome body/ANCA; Cryoglobulins; CXR for infiltrates (Wegner’s) Infectious agents : Syphilis; campylobacter jejuni; CMV; RPR/VDRL/FTA; CMV titers; Hepatitis panel (B&C), HIV tests,
Lyme; Leprosy; HIV; West Nile; Herpes virus. Note: Risk Lyme titers, West Nile & Herpes viral tests, CSF analysis
Varicella Zoster/VZV = 1/3 (1> 60 y.o.). PHN = 10-18%
Diseases of gut : Malabsorption; Short bowel syndrome; Vitamin/Mineral Levels: B1/Thiamine, B6 , Foltate, B12; D& E;
Sequalae bariatric Surgery (reference AANEM: Muscle & Iron, Calcium, Magnesium, Phosphorus, Selenium, Cooper & Zinc. Celiac disease antibodies: Gliadin, transglutaminase, Endomysial; Endoscopic biopsy for confirmation Sarcoidosis
Serum angiotensin converting enzyme/ACE; ACE CSF Heavy metal toxicity: most common – Arsenic,
Blood, urine, hair & nail analysis for heavy metals Bismuth, Cadmium, Lead, Mercury, Thallium
Blood Disorders: Pernicious Anemia; Porphyria (e.g.
Anti-intrinsic cell IgG Ab in up to 70% patients with Pernicious Acute Intermittent Porphyria/AIP (Autosomal dominant) Anemia; Anti-Parietal cell Ab by ELISA has advantage over RIA detecting Abs to both type I & II (absent RIA false + when high B12 levels due to treatment); Urine, blood & stool for por- phyrins: Porphobilinogen deaminase deficiency   urinary lev- els of -Aminolevulinic acid (ALA) & Porphobilinogen (PBG) which establishes the diagnosis of acute Porphyria Hereditary: CMT, Hereditary Neuropathy Liability to
Specific genetic tests provides 100 % specificity (0% False +). Pressure Palsies (HNLPP) & Hereditary Amyloidosis (HA) Available for  # hereditary PN: CMT; HNLPP; HA Malignancies: Carcinoma, myeloma, lymphoma
Skeletal survey & bone scan; Mammography; CT &/or MRI Chest, ( US) Abdomen &/or Pelvis; PET; CSF with cytology; Serum para-neoplastic Ab profile: Anti-Hu & Anti-CV2 Table 3. Focus on Newer Medications; and a Multi-Modal Tiered Approach to Painful Peripheral Neuropathies
Therapy– First Line
Dose Range
Common Side Effects
TCA/SSRIs
Nausea, dizziness, fatigue, constipation Anti-Epileptic Drugs (AEDs)
100 mg  slowly: 100-300 mg up to 2400 - 3200 Nausea, sedation, dizziness/ataxia, fa-  slowly: 50-300 mg divide b.i.d.-t.i.d. Second Line Anti-Epileptic Drugs (AED) and Non-Opioid Analgesics
Tegretol (Carbemezapine)
100 mg  100-200 mg ->1600 mg/d divide t.i.d. Sedation, unsteadiness, nausea/vomit- ing, rash,  WBCs/platelets; hepatitis 50-400 mg/day divide t.i.d.-q.i.d. or ER GI side effects, sedation Other AEDs: Gabitril (Tiagabine); Lamictal (Lamotrigine);Topamax (Topiramate); Depakote (Valproate); Zonegran (Zonisamide)
Third Line & Alternatives
Mexitil (Mexiletine)
100 mg  by 100 mg up to 900 mg/d divide t.i.d. Arrhythmia, dizziness, vertigo, nausea (Not if AV conduction block)
Topicals: Capsaicin (Zostrix)(Sub P depletion); Lidoderm patch; Diclofenac; Compounding pharmacy combinations:
Anesthetics, Salicylates, Ketoprofen, TCA, Ketamine, Cyclobenzaprine, Baclofen, AEDs (Gabapentin, etc.)
Multi-modal therapy is often best: Non-narcotic and/or Opioid analgesics in combination with TCA/SSRIs & AEDs
Varicella Zoster/VZV): Acute- Oral antiviral agents, i.e. Acyclovir, Valacyclovir, Famicyclovir  Corticosteroids + analge-
sics (oral &/or topical), &/or TCA/SSRIs &/or AED/SSRIs. Consider root or epidural blocks; Prevention– Zoster Vaccine
Pending FDA approval– NGX-4010 (8% Capsaicin patches) for Post-herpetic neuralgia (PHN) & DPN
Drs. Ansari, Posuniak, Sundarum & Wang welcome Musculoskeletal & Spinal Management Referrals

Source: http://electrodiagnosis.net/NewsResearch/EandRNewsletter/Volume%2010%20Issue_1_2_09%20EVALUATION%20AND%20TREATMENT%20OF%20PERIPHERAL%20NEUROPATHY.pdf