What is Tigecycline (Tigecycline)?

From the Guidelines

Tigecycline should not be used as a first-line treatment for infections caused by Acinetobacter baumannii due to its limited efficacy and potential for increased mortality compared to other antibiotics, as shown in a recent study 1.

Overview of Tigecycline

Tigecycline is a broad-spectrum antibiotic belonging to the glycylcycline class, which is derived from tetracyclines. It is primarily used to treat complicated skin infections, complicated intra-abdominal infections, and community-acquired bacterial pneumonia. The standard dosing regimen is a 100 mg intravenous loading dose, followed by 50 mg intravenously every 12 hours.

Efficacy and Safety

However, its use in treating infections caused by Acinetobacter baumannii is limited due to concerns about its efficacy and safety. A study published in 2023 found that tigecycline-based therapy was associated with an average of 58 more deaths and 90 more clinical treatment failures compared to CMS-based combination therapies 1.

Alternative Treatment Options

Alternative treatment options, such as combination therapies with other antimicrobials, may be more effective in treating infections caused by Acinetobacter baumannii. A study published in 2022 found that high-dose tigecycline (HDT) regimen, with a loading dose of 200 mg and maintenance dose of 100 mg every 12 h, may have a role in critically ill patients infected with CRE, but further large-scale investigations are needed to support this recommendation 1.

Key Points to Consider

• Tigecycline should not be used as a first-line treatment for infections caused by Acinetobacter baumannii.
• Alternative treatment options, such as combination therapies with other antimicrobials, may be more effective.
• High-dose tigecycline (HDT) regimen may have a role in critically ill patients infected with CRE, but further studies are needed to confirm its efficacy and safety.
• Tigecycline is effective against many resistant organisms, including MRSA, VRE, and certain gram-negative bacteria with multi-drug resistance.
• Common side effects include nausea, vomiting, and diarrhea.
• Dose adjustment is necessary in severe hepatic impairment, and tigecycline should be used with caution in pregnant women as it may affect fetal bone development.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Tigesiklin (Tigecycline) Overview

• Tigecycline is a broad-spectrum, intravenous antibacterial agent that belongs to the glycylcycline class of antibiotics 2, 3, 4.
• It is designed to overcome the two major mechanisms of tetracycline resistance, namely ribosomal protection and efflux 2, 3, 4.

Mechanism of Action and Spectrum of Activity

• Tigecycline binds to the 30S subunit of bacterial ribosomes and inhibits protein synthesis by preventing the incorporation of amino acid residues into elongating peptide chains 4.
• It exhibits activity against a wide range of clinically significant Gram-positive and Gram-negative bacteria, including multidrug-resistant strains 2, 3, 4.

Clinical Efficacy and Tolerability

• Tigecycline has been shown to be effective in the treatment of complicated skin and skin structure infections (cSSSIs) and complicated intra-abdominal infections (cIAIs) 2, 3, 4, 5.
• It has also been evaluated for the treatment of community-acquired pneumonia (CAP) and has been found to be non-inferior to levofloxacin in hospitalized patients with CAP 2.
• Tigecycline is generally well tolerated, with the most frequent adverse events being nausea, vomiting, and diarrhea 2, 3, 4, 5.

Pharmacokinetics and Dosage

• Tigecycline has a large volume of distribution (7-9 L/kg) and is moderately bound to plasma protein (71%-89%) 4.
• The recommended dosage of tigecycline is 100 mg IV given as a loading dose, followed by 50 mg IV every 12 hours for 5 to 14 days 4.
• Dose adjustment may be necessary in patients with severe hepatic impairment (Child-Pugh class C) 4.