What is the recommended dosage of tigecycline (generic name) for neonates with Acinetobacter sepsis?

Tigecycline Dosing in Neonates with Acinetobacter Sepsis

There is no recommended dosage of tigecycline for neonates with Acinetobacter sepsis, and its use is not recommended in patients <18 years of age unless no alternative antimicrobial agents are available. 1

Current Recommendations and Limitations

• Tigecycline has no established dosing recommendations for neonates according to current guidelines 1
• Use of tigecycline is explicitly not recommended in patients under 18 years of age unless no alternative antimicrobial agents are available 1
• Pediatric infectious diseases specialist consultation is strongly advised prior to considering tigecycline use in any pediatric patient 1

Alternative First-Line Options for Acinetobacter Sepsis in Neonates

For neonates with Acinetobacter sepsis, consider the following age-appropriate alternatives:

• Meropenem:

  • Gestational age <32 weeks:
    • Postnatal age <14 days: 20 mg/kg/dose IV q12h 1
    • Postnatal age ≥14 days: 20 mg/kg/dose IV q8h 1
  • Gestational age ≥32 weeks:
    • Postnatal age <14 days: 20 mg/kg/dose IV q8h 1
    • Postnatal age ≥14 days: 30 mg/kg/dose IV q8h 1

• Imipenem:

  • Postnatal age ≤7 days: 25 mg/kg/dose IV q12h 1
  • Postnatal age >7 days: 25 mg/kg/dose IV q8h 1

• Colistin (for multidrug-resistant strains):

  • 2.5-5 mg CBA/kg/day IV in 2 or 4 divided doses 1

Tigecycline Use in Older Children (If Absolutely Necessary)

If all alternatives have been exhausted and tigecycline must be considered for older children:

• For children 8-11 years: 1.2-2 mg/kg/dose IV q12h 1
• For children ≥12 years: 50 mg/dose IV q12h 1

Limited Pediatric Experience with Tigecycline

• In a retrospective study of 24 pediatric patients (median age 4 years), tigecycline was administered at a loading dose of 1.5 or 2.0 mg/kg followed by 1.0 mg/kg every 12 hours 2
• Another case series of 13 children (median age 8 years) used loading doses of 1.8-6.5 mg/kg followed by maintenance doses of 1-3.2 mg/kg q12h, primarily for XDR Gram-negative infections 3
• Both studies reported no serious adverse events, but efficacy was limited, particularly in bloodstream infections 2, 3

Important Considerations and Cautions

• Tigecycline achieves low plasma concentrations, making it suboptimal for bloodstream infections 4
• For severe infections in adults, higher dosing (200 mg IV loading dose followed by 100 mg IV q12h) has shown better outcomes, but this has not been validated in children 4, 5
• Combination therapy is generally preferred over tigecycline monotherapy for multidrug-resistant organisms 4
• Infectious disease consultation is highly recommended for management of infections caused by multidrug-resistant organisms 1

Conclusion

Tigecycline should be avoided in neonates with Acinetobacter sepsis due to lack of established dosing recommendations and safety data. Alternative age-appropriate antibiotics should be used based on susceptibility testing. If tigecycline must be considered in older children as a last resort, pediatric infectious disease consultation is mandatory to guide dosing and monitoring.