What is the recommended dose of tigecycline (Tygacil) for treating infections?

Tigecycline Dosing Recommendations

The standard FDA-approved dosing regimen for tigecycline is an initial loading dose of 100 mg IV, followed by 50 mg IV every 12 hours, administered over 30-60 minutes. 1

FDA-Approved Indications

• Complicated skin and skin structure infections (cSSSIs)
• Complicated intra-abdominal infections (cIAIs)
• Community-acquired bacterial pneumonia (CAP)

Standard Dosing Protocol

• Loading dose: 100 mg IV
• Maintenance dose: 50 mg IV every 12 hours
• Administration: Infuse over 30-60 minutes
• Duration of therapy:
  • cSSSIs: 5-14 days
  • cIAIs: 5-14 days
  • CAP: 7-14 days 1

Special Population Considerations

Hepatic Impairment

• Mild to moderate impairment (Child-Pugh A and B): No dosage adjustment needed
• Severe hepatic impairment (Child-Pugh C):
  • Loading dose: 100 mg IV
  • Maintenance dose: Reduced to 25 mg IV every 12 hours
  • Monitor treatment response closely 1

Multidrug-Resistant Infections

• For carbapenem-resistant Enterobacterales (CRE) infections:
  • Loading dose: 100 mg IV
  • Maintenance dose: 50 mg IV every 12 hours
  • Often used in combination with other agents (e.g., colistin, meropenem) 2

Higher Dosing Regimens

For severe infections with multidrug-resistant organisms, higher doses have been suggested:

• Loading dose: 200 mg IV
• Maintenance dose: 100 mg IV every 12 hours 3, 4

This higher dosing regimen may be particularly beneficial for:

• Infections caused by organisms with higher MICs (≤1 mg/L)
• Severe infections requiring improved tissue penetration 4

Important Considerations and Limitations

Efficacy Concerns

• Tigecycline has poor serum concentrations (Cmax <0.87 mg/L with standard regimen)
• Not recommended for bloodstream infections due to poor outcomes 3
• The FDA has issued a warning about increased all-cause mortality compared to other antibiotics 1

Combination Therapy

• For multidrug-resistant infections, tigecycline is often recommended as part of combination therapy rather than monotherapy 2, 3
• When treating carbapenem-resistant Enterobacterales, consider combining with colistin or meropenem 2

Susceptibility Testing

• Tigecycline should be used when MIC ≤1 mg/L
• Always obtain susceptibility testing before treatment when possible 3

Preparation and Administration

1. Reconstitute each vial with 5.3 mL of 0.9% Sodium Chloride, 5% Dextrose, or Lactated Ringer's
2. Gently swirl until dissolved (10 mg/mL concentration)
3. Transfer to 100 mL IV bag for infusion
4. Maximum concentration in IV bag should be 1 mg/mL
5. Administer over 30-60 minutes 1

Tigecycline should be reserved for situations when alternative treatments are not suitable, due to its mortality risk and limited efficacy in certain infection types 1.