Is tigecycline (generic name) effective for treating Elizabethkingia meningoseptica infections?

Tigecycline for Elizabethkingia meningoseptica Infections

Tigecycline is an effective option for treating Elizabethkingia meningoseptica infections, particularly when used in combination therapy, though it should not be used as monotherapy for bacteremia or central nervous system infections. 1

Antimicrobial Activity Against E. meningoseptica

• E. meningoseptica is multidrug-resistant to many broad-spectrum antibiotics typically used for gram-negative infections, making treatment challenging 1
• Tigecycline has demonstrated good in vitro activity against clinical isolates of Elizabethkingia species with susceptibility rates of 78.8% 2
• Other antibiotics with good activity against E. meningoseptica include minocycline (100% susceptibility), rifampin (76.9%), and levofloxacin (71.2%) 2

Dosing Recommendations for E. meningoseptica Infections

• For severe E. meningoseptica infections, a high-dose regimen is recommended: 200 mg IV loading dose followed by 100 mg IV every 12 hours 3
• Standard dosing (100 mg IV loading dose followed by 50 mg IV every 12 hours) may be insufficient for bloodstream infections due to low serum Cmax of only 0.87 mg/L 3
• For CNS infections, tigecycline has been used intrathecally in combination with systemic antibiotics 4

Combination Therapy Approach

• Tigecycline should be used as part of combination therapy rather than monotherapy for E. meningoseptica infections 5, 4
• Successful treatment regimens have included tigecycline combined with:
  • Vancomycin and cotrimoxazole 4
  • Piperacillin-tazobactam 6
  • Rifampicin 1

Clinical Evidence for E. meningoseptica

• Case reports document successful treatment of E. meningoseptica meningitis using intrathecal tigecycline combined with systemic antibiotics 4
• In immunocompromised patients with E. meningoseptica bacteremia, combination therapy including tigecycline has shown efficacy 6
• For bloodstream infections, fluoroquinolones have demonstrated better outcomes than other antibiotics, with 14-day mortality of 8.3% vs 33.3% for non-fluoroquinolone treatment 7

Important Limitations and Considerations

• Tigecycline has been associated with higher mortality rates compared to other antibiotics in clinical studies 5
• Common adverse effects include nausea, vomiting, diarrhea, abdominal pain, and elevated liver enzymes 5
• Tigecycline should not be used as monotherapy for bacteremia due to poor outcomes with standard dosing 3
• For CNS infections, first-line recommendations typically include vancomycin, linezolid, or TMP-SMX rather than tigecycline 5
• Tigecycline is contraindicated in children under 8 years due to risk of teeth discoloration 5

Treatment Algorithm for E. meningoseptica Infections

1. For bloodstream infections:

   • First choice: Fluoroquinolone (levofloxacin) 7
   • Alternative: High-dose tigecycline (200mg loading, then 100mg q12h) in combination with another active agent 3, 1

2. For CNS infections:

   • Consider intrathecal tigecycline as part of combination therapy 4
   • Include systemic antibiotics like vancomycin and cotrimoxazole 4

3. For other severe infections:

   • Use combination therapy with tigecycline plus another active agent (piperacillin-tazobactam, cotrimoxazole, or rifampicin) 6, 1
   • Consider high-dose tigecycline regimen for better outcomes 3