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

Tigecycline Dosing in Neonates with Acinetobacter Sepsis

There are no established recommendations for tigecycline use in 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 is not approved for use in neonates, and current guidelines explicitly state "No recommendations available" for neonatal dosing 1
• Use of tigecycline is not recommended in patients <18 years of age unless no alternative antimicrobial agents are available 1
• Pediatric infectious diseases specialist consultation is strongly recommended 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 agents with established neonatal dosing before tigecycline:
  • Meropenem: For gestational age <32 weeks and postnatal age <14 days: 20 mg/kg/dose IV q12h; postnatal age ≥14 days: 20 mg/kg/dose IV q8h 1
  • Imipenem: For postnatal age ≤7 days: 25 mg/kg/dose IV q12h; postnatal age >7 days: 25 mg/kg/dose IV q8h 1
  • Colistin (IV): 2.5-5 mg CBA/kg/day IV in 2 or 4 divided doses 1

Potential Tigecycline Dosing if No Alternatives Available

If all other options have been exhausted and tigecycline must be used as a last resort:

• Limited pediatric data suggests a loading dose of 1.5-2.0 mg/kg followed by 1.0 mg/kg every 12 hours may be considered 2
• Another study reported tigecycline dosing in children as young as 2.5 months at loading doses of 1.8-6.5 mg/kg followed by maintenance doses of 1-3.2 mg/kg q12h 3
• Combination therapy is strongly recommended rather than tigecycline monotherapy for MDR organisms 4

Important Clinical Considerations

• Tigecycline has poor plasma concentrations which may limit efficacy in bloodstream infections 4
• In pediatric case series, mortality was significantly higher (86%) in bloodstream infections compared to non-bacteremic infections (24%) 3
• Tigecycline should always be used in combination with other active agents when treating Acinetobacter infections 4
• Close monitoring for adverse effects is essential, including:
  • Abnormal liver function 2
  • Prolonged prothrombin time 2
  • Diarrhea 2

Special Considerations for Neonates

• Pharmacokinetics of tigecycline in neonates is not well established 1
• The risk-benefit ratio must be carefully evaluated given the lack of safety data in this population 1
• If tigecycline is used, close consultation with pediatric infectious disease specialists, clinical pharmacists, and neonatologists is mandatory 1

Conclusion

Tigecycline should only be considered in neonates with Acinetobacter sepsis when all other appropriate antimicrobial options have been exhausted. If used, it should be administered in consultation with pediatric infectious disease specialists, with careful monitoring for efficacy and adverse effects.