Infectious Disease Compendium

Tigecycline (Tygacil®)

Dosing

CrCl Formula

CrCl > 80: loading dose 100 mg followed then 50 mg q 12 hours. Hepatic metabolism, so no change for increased GFR, but decrease for hepatic failure.

Hemodialysis: na.

Peritoneal dialysis: na

Important side effects

Nausea and vomiting (30%), pancreatitis (PubMed).

"Tigecycline is not as effective as other antibiotics with relatively more frequency of adverse events and higher mortality rate (PubMed)."

And Death. The drug has double the death rates of all comparator agents. (PubMed). "The estimated risk difference (tigecycline minus comparator) in all-cause mortality from the meta-analysis was 0.6% (95% confidence interval 0.1-1.2%). Statistical modelling identified baseline bacteraemia associated with mortality only in the tigecycline group. In patients with ventilator-associated pneumonia (VAP) and baseline bacteraemia, mortality was 50.0% (9/18) for tigecycline versus 7.7% (1/13) for the comparator group. Study-level and patient-level analyses have identified that patients in the hospital-acquired pneumonia trial, particularly those with VAP with baseline bacteraemia, were at a higher risk of clinical failure and mortality (PubMed)."

Glad I never saw fit to give it.

Important drug interactions

Rants and Screeds

Pearls

Resistance my develop to Acinetobacter while on therapy (PubMed).

Treatment of choice

Use for

Approved for intra abdominal infections and cellulitis. Susceptabilites include Staphylococcus aureus (MRSA, MSSA, glycopeptide-intermediate S. aureus including tetracycline resistant strains), Streptococcus pneumoniae (including tetracycline resistant strains), viridans group Streptococci, Escherichia coli, Enterococcus faecalis, Enterococcus faecium, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter aerogenes, Citrobacter freundii, Haemophilus influenzae, and Moraxella catarrhalis. Useful in MDR Acinetobacter.

Don't use for

Burkholdia, Proteus, Pseudomonas Poor penetration into urince, so should me avoided in the treatment of UTI's.

Be warned, there is "an increased mortality risk associated with the use of the intravenous antibacterial Tygacil (tigecycline) compared to that of other drugs used to treat a variety of serious infections. The increased risk was seen most clearly in patients treated for hospital-acquired pneumonia, especially ventilator-associated pneumonia, but was also seen in patients with complicated skin and skin structure infections, complicated intra-abdominal infections and diabetic foot infections (FDA)."

The drug is inferior to comparators, or should I say non-non-inferior, for pneumonia, espcially ventillator associated pneumonia, and should probably only be used when there are zero other options. As I write this on 7/11 (the date, not the store) I have yet to give the drug.

Class

Glycylcyclines (a fancy schamncy minocycline; give it a new class and you can charge more).