From the Guidelines
The recommended dose of tigecycline for adults is an initial loading dose of 200 mg given intravenously, followed by 100 mg every 12 hours, as this high-dose regimen has been shown to significantly lower mortality among patients infected with multidrug-resistant organisms, including carbapenem-resistant bacteria 1. This dosing strategy is supported by a recent meta-analysis that demonstrated a statistically lower mortality rate in the high-dose tigecycline group compared to the standard dose group 1.
Key Considerations
- The standard dose of tigecycline, which is a 100-mg loading dose followed by 50 mg every 12 hours, may not be sufficient for the treatment of severe infections, particularly those caused by multidrug-resistant bacteria 1.
- The high-dose regimen of tigecycline has been shown to be safe and effective in combination with other antimicrobials for the treatment of severe infections due to multidrug-resistant bacteria 1.
- Tigecycline should be administered as a slow intravenous infusion over 30 to 60 minutes and should not be given as a bolus injection.
- The duration of treatment varies by infection type, but the high-dose regimen should be considered for critically ill patients infected with multidrug-resistant organisms.
Rationale
The high-dose regimen of tigecycline is recommended based on the most recent and highest quality evidence, which suggests that this dosing strategy can improve outcomes in patients with severe infections caused by multidrug-resistant bacteria 1. While the standard dose of tigecycline may be effective for some infections, the high-dose regimen is preferred for the treatment of severe infections, particularly those caused by carbapenem-resistant bacteria.
Important Notes
- Tigecycline is not approved for the treatment of bacteremia, but it may have a role in combination therapy for carbapenem-resistant bacterial infections 1.
- The use of tigecycline should be guided by susceptibility testing and clinical judgment, as the efficacy of the drug can vary depending on the specific infection and the causative organism 1.
From the FDA Drug Label
2.1 Recommended Adult Dosage The recommended dosage regimen for tigecycline for injection is an initial dose of 100 mg, followed by 50 mg every 12 hours.
The recommended dose of Tigecycline for treating infections in adults is an initial dose of 100 mg, followed by 50 mg every 12 hours 2.
- The dose may vary based on the severity and site of the infection and the patient’s clinical and bacteriological progress.
- For patients with severe hepatic impairment, the initial dose is 100 mg followed by a reduced maintenance dose of 25 mg every 12 hours.
- For pediatric patients, the dose is suggested as 1.2 mg/kg every 12 hours for patients aged 8 to 11 years (to a maximum dose of 50 mg every 12 hours), and 50 mg every 12 hours for patients aged 12 to 17 years.
From the Research
Tigecycline Dosage
The recommended dose of Tigecycline for treating infections is as follows:
- Initial dose: 100 mg intravenously 3, 4, 5, 6
- Maintenance dose: 50 mg intravenously every 12 hours 3, 4, 5, 6
- Duration of treatment: 5-14 days 3, 4, 5, 6
Special Considerations
- In patients with severe hepatic impairment, the maintenance dose should be reduced by 50% 4
- No dose adjustment is necessary based on age, sex, or mild to moderate hepatic impairment 4
- Once daily high dose tigecycline (200-400 mg IV) has been used in some clinical settings, but optimal dosing is dependent on pharmacokinetic/pharmacodynamic (PK/PD) considerations 7