What is the recommended dose administration of tigecycline (generic name) for adults with complicated skin and skin structure infections, intra-abdominal infections, and community-acquired pneumonia?

Tigecycline Dosing Recommendations for Adults

The recommended dose administration for tigecycline in adults is a 100 mg intravenous loading dose, followed by 50 mg intravenously every 12 hours for complicated skin and skin structure infections, intra-abdominal infections, and community-acquired pneumonia. 1, 2, 3

Standard Dosing for Approved Indications

• For complicated skin and skin structure infections (cSSSI), the recommended dosage is 100 mg IV loading dose, followed by 50 mg IV every 12 hours for 5-14 days 2, 4
• For complicated intra-abdominal infections (cIAI), the recommended dosage is 100 mg IV loading dose, followed by 50 mg IV every 12 hours for 5-14 days 1, 4
• For community-acquired bacterial pneumonia (CAP), the recommended dosage is 100 mg IV loading dose, followed by 50 mg IV every 12 hours for 7-14 days 2, 5, 6
• No dose adjustment is required for patients with renal impairment 2

Special Populations and Considerations

• For patients with severe hepatic impairment (Child-Pugh C), a dose adjustment is recommended: 100 mg IV loading dose, followed by 25 mg IV every 12 hours 2
• For patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD), although not licensed for this indication in the UK, the dosage is 100 mg loading dose, then 50 mg twice daily 1
• For children 12-18 years: 100 mg loading dose, then 50 mg twice daily (intravenous) 1
• For children 8-11 years: 1.2 mg/kg twice daily (maximum 50 mg twice daily) (intravenous) 1
• Tigecycline is not recommended for children under 8 years due to risk of teeth discoloration 1

Specific Clinical Scenarios

• For carbapenem-resistant Enterobacterales (CRE) complicated intra-abdominal infections, tigecycline can be used at a dose of 100 mg IV loading dose, then 50 mg IV q12h 1
• For vancomycin-resistant Enterococci (VRE) complicated intra-abdominal infections, the recommended dose is 50 mg IV q12h after loading dose of 100 mg IV 1
• For carbapenem-resistant Acinetobacter baumannii infections, tigecycline can be used in combination with colistin at a dose of 100 mg IV loading dose, then 50 mg IV q12h 1

Important Clinical Caveats

• Tigecycline should not be used as monotherapy for bacteremia due to poor outcomes with standard dosing 2
• The FDA has issued a boxed warning regarding increased all-cause mortality with tigecycline use 3
• Tigecycline is not recommended for the treatment of hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) due to increased mortality compared to control groups 1
• Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, headache, and elevated liver enzymes 1, 4
• Tigecycline is contraindicated in patients with hypersensitivity to tigecycline or tetracyclines 1
• Pregnancy and breast feeding are contraindications (evidence of fetal harm in animal studies) 1

Administration

• Tigecycline is available as 50 mg powder for solution for infusion 1
• The drug should be administered intravenously over 30-60 minutes 2
• For complicated skin and skin structure infections, pharmacokinetic/pharmacodynamic studies suggest good clinical outcomes with standard dosing for infections with MICs ≤ 0.25 mg×L-1 7
• For complicated intra-abdominal infections, standard dosing is effective for infections with MICs ≤ 1 mg×L-1 7