Tetracyclines have been used for treatment of a wide variety of gram-positive and gram-negative bacterial infections since the 1950s. In addition to being effective against traditional bacteria, tetracyclines have been used to treat infections due to intracellular chlamydiae, mycoplasmas, rickettsiae, and protozoan parasites and a variety of noninfectious conditions. They are important for treatment of and prophylaxis against infections with bacteria that could be used in biological weapons. Bacterial resistance to tetracycline was identified shortly after the introduction of therapy. At present, tetracycline resistance in bacteria can occur by acquisition of >or=1 of the 36 different genes, by mutations to host efflux pumps or in their 16S rRNA sequences, or by alteration in the permeability of the cell. In contrast, tetracycline resistance has not yet been described in protozoa or other eukaryotic organisms.