From the Guidelines
For tigecycline treatment of bacteremia, the recommended dose is 100 mg IV as an initial loading dose, followed by 50 mg IV every 12 hours, as stated in the most recent guidelines 1. This regimen should typically be continued for 7-14 days depending on the severity of infection and clinical response. Tigecycline achieves relatively low serum concentrations due to its large volume of distribution, which has raised concerns about its efficacy for bloodstream infections. For this reason, some clinicians use higher doses (100 mg loading followed by 75-100 mg every 12 hours) for severe bacteremia, particularly with multidrug-resistant organisms, though this is off-label. Key points to consider when using tigecycline include:
- Administration through a dedicated IV line or Y-site over 30-60 minutes
- Monitoring for common adverse effects including nausea, vomiting, and elevated liver enzymes
- Notable gaps in coverage for Pseudomonas aeruginosa and Proteus species
- Generally reserved for situations with limited treatment options or polymicrobial infections requiring broad coverage, due to concerns about increased mortality compared to other antibiotics 1. It's also important to note that tigecycline should not be used for the treatment of VRE bacteremia due to its low serum levels, as recommended by recent guidelines 1. In cases of VRE infections, other treatment options such as daptomycin, linezolid, and fosfomycin may be considered, depending on the specific circumstances and the severity of the infection 1.
From the FDA Drug Label
The recommended dosage regimen for TYGACIL is an initial dose of 100 mg, followed by 50 mg every 12 hours. TYGACIL is indicated in patients 18 years of age and older for the treatment of community-acquired bacterial pneumonia caused by susceptible isolates of Streptococcus pneumoniae (penicillin-susceptible isolates), including cases with concurrent bacteremia.
The dose of Tygecycline for bacteriaemia is an initial dose of 100 mg, followed by 50 mg every 12 hours.
- This dosage is for the treatment of community-acquired bacterial pneumonia, which can include cases with concurrent bacteremia.
- The dosage regimen should be administered intravenously over approximately 30 to 60 minutes every 12 hours 2.
- It is essential to note that TYGACIL should be reserved for use in situations when alternative treatments are not suitable due to the increased risk of all-cause mortality associated with its use 2.
From the Research
Tygecycline Bacteriaemia Dose
There is no direct information available on the dosage of Tygecycline for bacteriaemia. However, the provided studies discuss the treatment of bacterial infections, including bacteriaemia, using other antibiotics.
Alternative Treatment Options
- Piperacillin-tazobactam is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity, including against Gram-positive and Gram-negative aerobic and anaerobic bacteria 3.
- Meropenem is a carbapenem antibiotic that is effective against a wide range of bacterial infections, including those caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria 4, 5, 6, 7.
- The combination of piperacillin-tazobactam and amikacin may be a potential carbapenem-sparing regimen for the treatment of urosepsis caused by ESBL-producing E. coli 6.
Study Findings
- A study comparing piperacillin-tazobactam with meropenem for the treatment of bloodstream infections caused by AmpC β-lactamase-producing Enterobacter spp. found that piperacillin-tazobactam may lead to more microbiological failures, although fewer microbiological relapses were seen 4.
- Another study found that the combination of piperacillin-tazobactam and amikacin demonstrated rapid bacterial killing and did not result in the emergence of resistant subpopulations 6.
- The PeterPen trial is currently investigating the non-inferiority of piperacillin-tazobactam compared to meropenem for the treatment of third-generation cephalosporin-resistant Escherichia coli and Klebsiella bloodstream infections 7.