From the Guidelines
Tigecycline can be stepped down to eravacycline due to its higher in vitro antibacterial activity and lower incidence of adverse events compared to tigecycline 1.
Key Points
- Eravacycline has 2-8 times higher in vitro activity against CRAB and CRE compared to tigecycline 1.
- Eravacycline shows higher lung tissue concentration and lower incidence of adverse events compared to tigecycline 1.
- Tigecycline is not recommended for infections caused by 3GCephRE due to its low serum levels and large volume of distribution 1.
- Eravacycline is a suitable alternative for step-down therapy due to its broad-spectrum activity against Gram-positive and Gram-negative aerobic bacteria, including VRE 1.
Considerations
- The choice of step-down therapy should be based on individual patient factors, such as the severity of infection, renal function, and susceptibility patterns of the isolate 1.
- Antibiotic stewardship should be considered when selecting step-down therapy to minimize the development of resistance and optimize patient outcomes 1.
The FDA Drug Labels for tigecycline (IV) do not address this question.
From the Research
Antibiotic Options for Step-Down Therapy from Tigecycline
There are no specific studies that directly address the step-down therapy from Tigecycline to another antibiotic. However, based on the available evidence, the following antibiotics may be considered as alternatives for step-down therapy:
- Vancomycin and aztreonam combination, as tigecycline has been shown to have equivalent efficacy and safety compared to this combination for complicated skin and skin-structure infections (cSSSIs) 2
- Imipenem/cilastatin, as tigecycline was found to be as effective as this combination for complicated intra-abdominal infections (cIAIs) 2
- Other broad-spectrum antibiotics, such as advanced generation cephalosporins, carbapenems, fluoroquinolones, piperacillin/tazobactam, and gram-positive directed agents (e.g. daptomycin, linezolid and quinupristin/dalfopristin), may also be considered as alternatives for step-down therapy, although resistance to these agents is increasingly being reported 2
Key Considerations
When selecting an antibiotic for step-down therapy from Tigecycline, the following factors should be considered:
- The type and severity of the infection
- The susceptibility of the causative organism to the selected antibiotic
- The potential for resistance to the selected antibiotic
- The patient's clinical response to Tigecycline therapy
- The availability of alternative antibiotics and their potential side effects 3, 4, 5, 2, 6