Tigecycline Dosing Recommendations
The recommended standard dosage for tigecycline is a 100 mg IV loading dose followed by 50 mg IV every 12 hours, administered over 30-60 minutes, with treatment duration of 5-14 days depending on the infection type. 1
Standard Dosing Regimen
- The FDA-approved standard dosage for tigecycline is 100 mg IV loading dose followed by 50 mg IV every 12 hours 1
- Intravenous infusions should be administered over approximately 30 to 60 minutes 1
- No dosage adjustment is required for patients with renal impairment or those on continuous renal replacement therapy 2, 1
- For patients with severe hepatic impairment (Child Pugh C), the initial dose should remain 100 mg followed by a reduced maintenance dose of 25 mg every 12 hours 1
Treatment Duration by Infection Type
- Complicated skin and skin structure infections: 5-14 days 1
- Complicated intra-abdominal infections: 5-14 days 1
- Community-acquired bacterial pneumonia: 7-14 days 1, 3
Higher Dosing for Severe Infections
- For severe infections, particularly pulmonary infections, a high-dose regimen may be more effective: 200 mg IV loading dose followed by 100 mg IV every 12 hours 2
- This higher dosing regimen has shown improved cure rates (85%) compared to standard dosing (69.6%) in hospital-acquired pneumonia 2
- Standard dosing achieves serum Cmax of only 0.87 mg/L, which may be insufficient for bloodstream infections 2, 4
Specific Clinical Scenarios
- For carbapenem-resistant Enterobacterales (CRE) infections, tigecycline can be used in combination therapy with polymyxins or meropenem, with a recommended dose of 100 mg IV loading dose, then 50 mg IV q12h 4, 2
- For complicated intra-abdominal infections due to vancomycin-resistant Enterococci (VRE), the recommended dose is 50 mg IV q12h after loading dose of 100 mg IV 4
- For Acinetobacter baumannii infections, standard dosing is appropriate for approved indications, but higher dosing may be needed for other indications 4, 2
Important Clinical Caveats
- Tigecycline is not indicated for the treatment of diabetic foot infections 1
- Tigecycline is not indicated for the treatment of hospital-acquired or ventilator-associated pneumonia due to greater mortality and decreased efficacy reported in clinical trials 1
- Tigecycline should not be used as monotherapy for bacteremia due to poor outcomes with standard dosing 2, 5
- For multi-drug resistant organisms, combination therapy is generally preferred over tigecycline monotherapy 2, 6
- An increase in all-cause mortality has been observed in clinical trials comparing tigecycline to other antibiotics, so it should be reserved for situations when alternative treatments are not suitable 1
Pharmacokinetic Considerations
- Tigecycline has a prolonged post-antibiotic effect against key bacteria and a long serum elimination half-life 3
- The drug effectively penetrates lung tissue but has low concentrations in endothelial lining fluid, which may explain lower efficacy in ventilator-associated pneumonia with standard dosing 4, 2
- Once-daily high-dose tigecycline (200-400 mg IV x1, then 100-200 mg IV q24h) has been studied for severe systemic infections and those due to MDR gram-negative pathogens 6