From the Guidelines
Tigecycline is not recommended for use in a 4-year-old patient due to potential risks of permanent tooth discoloration and enamel hypoplasia, as well as effects on bone growth, as suggested by the guidelines and recommendations for the treatment of infections due to multidrug-resistant organisms 1. The primary concern with using tigecycline in young children is that, as a tetracycline-class antibiotic, it can cause permanent tooth discoloration and enamel hypoplasia during tooth development, which occurs until approximately age 8. Some key points to consider when evaluating the use of tigecycline in pediatric patients include:
- The FDA has approved tigecycline only for patients aged 18 years and older, though in some countries it may be used in children 8 years and older in specific circumstances.
- The guidelines suggest that pediatric infectious diseases specialists consultation is recommended prior to the use of certain antibiotics in children, implying a need for careful consideration and alternative options.
- Alternative antibiotics such as piperacillin-tazobactam, carbapenems, or appropriate combinations of other antibiotics should be considered instead, based on the specific infection, local resistance patterns, and the child's clinical condition, as outlined in the guidelines for the treatment of infections due to multidrug-resistant organisms 1. In life-threatening infections where no alternatives exist, some specialists might consider using tigecycline in a 4-year-old under careful supervision, but this would be an off-label use requiring careful risk-benefit assessment. The guidelines and recommendations for the treatment of infections due to multidrug-resistant organisms provide a framework for evaluating the use of tigecycline in pediatric patients, emphasizing the importance of careful consideration and alternative options 1.
From the FDA Drug Label
Use in patients under 18 years of age is not recommended. Safety and effectiveness in pediatric patients below the age of 18 years have not been established. Because of effects on tooth development, use in patients under 8 years of age is not recommended
The patient is 4 years old, and according to the drug label, use in patients under 8 years of age is not recommended due to effects on tooth development. Therefore, Tigecycline should not be used in this patient. 2
From the Research
Tigecycline Usage
- Tigecycline is a broad-spectrum antibiotic that can be used to treat various serious infections, including complicated skin and skin-structure infections, complicated intra-abdominal infections, and community-acquired bacterial pneumonia 3, 4, 5, 6.
- The antibiotic has been shown to be effective against a wide range of multidrug-resistant pathogens, including vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and many species of multidrug-resistant gram-negative bacteria 3, 4, 6.
Safety and Efficacy
- Tigecycline has been found to be generally well-tolerated, with common side effects including nausea and vomiting 4, 5.
- However, recent studies have suggested an increased risk of death in patients receiving tigecycline compared to other antibiotics, particularly in patients with hospital-acquired pneumonia 7.
- The FDA has issued a black box warning for tigecycline due to the increased risk of mortality in certain patient populations 7.