From the Guidelines
Tigecycline is not recommended for use in a 4-month-old patient due to significant risks and lack of established safety profile in infants. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli, published in 2022 1, do not support the use of tigecycline for infections caused by third-generation cephalosporin-resistant Enterobacterales (3GCephRE) or carbapenem-resistant Enterobacterales (CRE).
Key Points to Consider
- The use of tigecycline in infants poses significant risks, including permanent tooth discoloration, enamel hypoplasia, and bone growth inhibition, due to its binding to calcium in developing teeth and bones.
- The safety profile, pharmacokinetics, and appropriate dosing of tigecycline have not been established in infants, making it potentially dangerous to use in this age group.
- Alternative antibiotics with established safety profiles should be used based on the specific infection type, severity, and local resistance patterns.
Recommendations for Treatment
- For bacterial infections in 4-month-old infants, consult with a pediatric infectious disease specialist to determine the best course of treatment.
- Consider using alternative antibiotics that are FDA-approved for use in infants and have established safety profiles.
- Always prioritize the use of antibiotics that are safe and effective for the specific infection being treated, taking into account local resistance patterns and the severity of the infection.
From the Research
Tigecycline Usage
- Tigecycline is a broad-spectrum antibiotic effective against various multidrug-resistant Gram-positive and Gram-negative pathogens 2, 3.
- It is approved for use in complicated skin and skin structure infections, complicated intra-abdominal infections, and community-acquired bacterial pneumonia in adults 3.
Duration of Treatment
- There is no specific information available on the use of tigecycline for a duration of 4 months 2, 4, 5, 6, 3.
- However, studies have shown that tigecycline can be used for the treatment of severe infections, including those caused by extensively drug-resistant Gram-negative bacteria, with a duration of treatment varying depending on the type and severity of the infection 5, 6.
Safety and Efficacy
- High-dose tigecycline has been shown to be effective and safe for the treatment of severe infections, with lower all-cause mortality, higher clinical cure, and microbiological eradication rates compared to standard-dose tigecycline or other antibiotics 5.
- However, the use of tigecycline has been associated with an increased risk of mortality in some studies, particularly in patients with hospital-acquired pneumonia 4.
- In pediatric patients, tigecycline has been used as salvage therapy for infections caused by extensively drug-resistant Gram-negative bacteria, with relatively good clinical response and no serious adverse events reported 6.