What is the recommended dose of Tigecycline (generic name) for patients with normal and impaired renal function?

Tigecycline Dosing Recommendations

The standard recommended dosage of tigecycline is a 100 mg IV loading dose, followed by 50 mg IV every 12 hours for most infections, with higher doses required for severe infections or multidrug-resistant organisms. 1

Standard Dosing Regimen

For patients with normal renal function:

• Loading dose: 100 mg IV once
• Maintenance dose: 50 mg IV every 12 hours
• Duration: 5-14 days depending on the type and severity of infection 1

Dosing in Special Populations

Hepatic Impairment

• Mild to moderate hepatic impairment (Child-Pugh A and B): No dosage adjustment required
• Severe hepatic impairment (Child-Pugh C): 100 mg loading dose, followed by 25 mg every 12 hours 1

Renal Impairment

• No dosage adjustment is necessary for patients with renal impairment or those undergoing hemodialysis 1

Pediatric Patients

• Children 12-18 years: 100 mg loading dose, then 50 mg twice daily
• Children 8-11 years: 1.2 mg/kg twice daily (maximum 50 mg twice daily)
• Children <8 years: Not recommended due to lack of data and risk of teeth discoloration 2, 1

Higher Dosing for Specific Indications

Bloodstream Infections

• For multidrug-resistant organisms causing bacteremia, a high-dose regimen is recommended:
  • Loading dose: 200 mg IV once
  • Maintenance dose: 100 mg IV every 12 hours 3
• This higher dosing is necessary because standard dosing results in low serum concentrations (Cmax <0.87 mg/L) and poor outcomes in bacteremia 3

Carbapenem-Resistant Enterobacterales (CRE)

• For bloodstream infections with CRE, tigecycline should be used in combination therapy:
  • Loading dose: 100 mg IV
  • Maintenance dose: 50 mg IV every 12 hours
  • Combined with colistin or meropenem 2

Acinetobacter baumannii Infections

• For pulmonary infections caused by A. baumannii with MIC ≤1 mg/L:
  • Loading dose: 200 mg IV
  • Maintenance dose: 100 mg IV every 12 hours 2
• For approved indications (cSSSIs and cIAIs) with A. baumannii, standard dosing may be appropriate 2

Administration Guidelines

• Administer as intravenous infusion over approximately 30-60 minutes
• Reconstitute with 5.3 mL of 0.9% Sodium Chloride, 5% Dextrose, or Lactated Ringer's
• Further dilute in 100 mL IV bag for infusion 1

Important Considerations

Efficacy Concerns

• Tigecycline has been associated with increased mortality compared to other antibiotics in clinical trials
• It should be reserved for situations when alternative treatments are not suitable 1

Combination Therapy

• For severe infections, especially those caused by multidrug-resistant organisms, combination therapy is recommended rather than tigecycline monotherapy 2, 3

Limitations

• Not indicated for diabetic foot infections or hospital-acquired/ventilator-associated pneumonia due to decreased efficacy in clinical trials 1
• Poor outcomes have been reported when used as monotherapy for bacteremia due to low serum concentrations 3

Monitoring

• Monitor liver function tests, particularly in patients with hepatic impairment
• Watch for common adverse effects including nausea, vomiting, and diarrhea 1

Remember that tigecycline dosing should be tailored based on the specific infection site, causative organism, and patient factors, with higher doses being necessary for more severe infections or resistant organisms.