Tigecycline Dosing in Adults
The standard recommended dosage of tigecycline for adults is a loading dose of 100 mg intravenously, followed by 50 mg intravenously every 12 hours for 5-14 days, administered over approximately 30-60 minutes. 1
Standard Dosing Regimen
- Initial dose: 100 mg IV once
- Maintenance dose: 50 mg IV every 12 hours
- Duration: 5-14 days (depending on infection type)
- Administration: Infuse over 30-60 minutes
Approved Indications
- Complicated skin and skin structure infections
- Complicated intra-abdominal infections
- Community-acquired bacterial pneumonia 1
Dosage Adjustments
Hepatic Impairment
- Mild to moderate hepatic impairment (Child-Pugh A and B): No dosage adjustment needed
- Severe hepatic impairment (Child-Pugh C):
- Initial dose: 100 mg IV once
- Maintenance dose: 25 mg IV every 12 hours 1
Special Populations
Pediatric Patients (not FDA approved, use only when no alternatives exist)
- Ages 12-18 years: 100 mg loading dose, then 50 mg twice daily
- Ages 8-11 years: 1.2 mg/kg twice daily (maximum 50 mg twice daily) 2, 1
- Not recommended for children under 8 years due to risk of teeth discoloration 2
Renal Impairment
- No dosage adjustment required for renal impairment or hemodialysis 1
High-Dose Regimen for Severe Infections
For severe infections, particularly those caused by multidrug-resistant organisms:
- Loading dose: 200 mg IV once
- Maintenance dose: 100 mg IV every 12 hours 3
This high-dose regimen may be particularly important for:
- Bloodstream infections (standard dosing results in low serum concentrations with Cmax <0.87 mg/L) 2
- Pulmonary infections caused by A. baumannii 2, 3
Preparation and Administration
- Reconstitute each vial with 5.3 mL of 0.9% Sodium Chloride Injection, USP, 5% Dextrose Injection, USP, or Lactated Ringer's Injection, USP
- Gently swirl until dissolved to achieve a concentration of 10 mg/mL
- Transfer and further dilute for IV infusion:
- For 100 mg dose: Reconstitute two vials and add to a 100 mL IV bag
- For 50 mg dose: Reconstitute one vial and add to a 100 mL IV bag 1
Common Adverse Effects
- Gastrointestinal: nausea (28.5%), vomiting (19.4%), diarrhea (11.6%) 4
- Local IV-site reactions (8.2%)
- Headache (5.6%)
Important Warnings
- Increased all-cause mortality has been observed in meta-analysis of clinical trials
- Not indicated for diabetic foot infections or hospital-acquired/ventilator-associated pneumonia 1
- For severe infections, especially with multidrug-resistant organisms, combination therapy is often preferred over tigecycline monotherapy 3
Tigecycline should be reserved for use in situations when alternative treatments are not suitable due to the observed increased mortality risk.