From the Guidelines
The recommended dose of Tigecycline for adults is an initial loading dose of 100 mg intravenously, followed by 50 mg intravenously every 12 hours. This dosing regimen is based on the most recent and highest quality study available, which recommends this dose for intraabdominal infections due to multidrug-resistant organisms 1.
Key Considerations
- The treatment duration is dependent on the site of infection and clinical response, and may vary from 5 to 14 days.
- For patients with severe hepatic impairment (Child-Pugh C), the maintenance dose should be reduced to 25 mg every 12 hours after the initial 100 mg loading dose.
- No dose adjustment is needed for patients with renal impairment or mild to moderate hepatic impairment.
- Tigecycline is administered as a slow intravenous infusion over 30 to 60 minutes and should not be given as a bolus injection.
Mechanism of Action
Tigecycline works by binding to the 30S ribosomal subunit, inhibiting bacterial protein synthesis, and is effective against many gram-positive, gram-negative, and anaerobic bacteria, including some multidrug-resistant strains.
Adverse Effects
This dosing regimen achieves effective antimicrobial concentrations while minimizing adverse effects such as nausea and vomiting, which are common with tigecycline.
Clinical Evidence
The recommended dose is supported by clinical evidence from studies published in reputable journals, including the Journal of Microbiology, Immunology and Infection 1 and the World Journal of Emergency Surgery 1. While other studies have investigated the use of tigecycline in different contexts, such as the treatment of Acinetobacter baumannii infections 1, the recommended dose remains the same.
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 (Child Pugh C), the initial dose is 100 mg followed by a reduced maintenance dose of 25 mg every 12 hours.
From the Research
Tigecycline Dosing Information
- The recommended dose of Tigecycline for treating infections is as follows:
- For complicated skin and skin structure infections, and complicated intra-abdominal infections, the recommended dosage regimen is 100 mg initially, followed by 50 mg every 12 hours for 5-14 days 3, 4
- For community-acquired pneumonia, the recommended dosage regimen is 100 mg initially, followed by 50 mg every 12 hours for 7-14 days 3
- Once daily high dose Tigecycline (200 - 400 mg IV x 1, then 100 - 200 mg IV q24 h) has been used for severe systemic infections, and has shown optimal efficacy when dosed based on pharmacokinetic/pharmacodynamic (PK/PD) principles 5
- The clinical and microbiological efficacy of Tigecycline for complicated skin-soft-tissue and intra-abdominal infections has been evaluated, and the results suggest that Tigecycline can be safely used in the treatment of different infections, with a clinical cure rate of 85.0% in patients with intra-abdominal infections and 73.1% in patients with skin-soft-tissue infections 6
Special Considerations
- The use of Tigecycline should be guided by susceptibility testing, and the minimum inhibitory concentration (MIC) value should be determined, especially when treating infections caused by Acinetobacter (MDR Acinetobacter, in particular) 6
- Tigecycline has shown effectiveness against a wide range of multidrug-resistant nosocomial pathogens, including MSSA/MRSA, VSE/VRE, B. fragilis, C. difficile, and MDR GNB 5, 7